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LMC Email update April 2018

Date sent: Tuesday 24 April 2018

Easter seems a long time ago and the roads are getting busier because the kids have now gone back to school, so I suppose we are all getting back to the normal working routine in our practices. 

Although reflecting on that there is very little that is 'normal' about the average day in a practice. 

The days I spend in my Practice are interesting and rewarding because there is considerable variety and I work in a very supportive practice with patients who generally appreciate all that we do for them.   I am only too well aware that for some this is not the case in which case the working day can be somewhat different.

The LMC continues to work towards making general practice a better place to work.


1. Shingles immunisation programme

Good news reduced numbers of people presenting with shingles and now you can offer the immunisation throughout the year.

2. HPV Patient Group Directives  published

PGDs are a useful tool for practices and a link to Public Health England and all PGDs.

3. Primary Care Networks

This forms a significant part of the planning guidance for the NHS for the coming year. This term is not new but reflects the importance placed on building on the registered list and working together in 'natural communities of care' with populations of 30-50,000.

4. Hampshire Health Record - now called CHIE (Care and Health Information Exchange)

This is helping save more and more lives with more practices contributing data and more people appropriately accessing this information for patient benefit. 

5. Cameron Fund

The only charity specifically for GPs, some feedback on the amount donated by local GPs.


Sorry guys but will be a regular topic in all our emails.  We are working closely with LMC Law to produce some simple help, guidance and training, and will share the details with you shortly. key message, 'don't panic'!

7. Appraisals and Revalidation

A gentle reminder to all!

8. Reimbursement for a phased return to work

Some good news about improvements to the sickness reimbursement.

9. Appointments with GPs

Could the Daily Mail be changing its focus to be supportive of GPs?

10. Cancer referrals block in bid to cut costs 

Another Daily Mail report, have you experienced this?

1. Shingles immunisation programme

I have attached a letter from PHE and NHSE regarding the evaluation of the programme which not only suggests a reduction in clinical cases but also therefore has an impact on GP consultations. Practices can now offer the shingles vaccine opportunistically to patients throughout the year as they become of eligible age.

Evidence from the early implementation of this programme shows that there has been approximately 17,000 fewer herpes zoster episodes and 3,300 fewer episodes of post-herpetic neuralgia amongst the 5.5 million individuals targeted for vaccination in the first 3 years of the programme.


2. HPV Patient Group Directives  published

The PGD template (v02.00) for HPV vaccine for adolescent females has now been published, and is available (see attached).

This template supports the administration of HPV vaccine to girls from 12 years of age or from school year 8 in accordance with the national immunisation programme, and is valid from 1 May 2018 to 30 April 2020.

The PGD for men (MSM) has also been published, although this is not for General Practice but for vaccination of MSM through Specialist Sexual Health Services and HIV clinics. The operational guidance is available here .

All PGD templates are available on the Public Health England website , and a link to this page is available on the vaccs and imms webpage on the BMA website.


3. Primary Care Networks

Earlier this year NHS England published its planning guidance for 2018/9, which described the plan for geographical based local primary care networks.

Primary Care Networks are likely to be formed around natural communities based on GP registered lists, serving populations of around 30,000 to 50,000 and involving primary care providers including general practice, pharmacy and some community and social care services. They will enable services to deliver better integrated primary and community care for patients and will provide a platform for providers of care being sustainable into the longer term.

In my previous emails I have repeatedly stated that the NHS has to build on the strengths of general practice as the major building blocks of care but we then need to be able to deliver out of hospital services at scale.  Once you get much bigger than 50,000 you end up making the network remote from general practice.  The benefit will be gained by local services supporting and integrating with local practices and where appropriate general practice and community services working together as one.

One lesson I would take from the work done in the Vanguards was that there were a number of benefits delivered but where there was a gap was in building these natural communities of care which are large enough to gain influence and power but small enough to be flexible, cohesive and effective.

Names may change but these networks are part of the Primary Care Home initiatives, but to be effective they will need to be resourced. 


4. Hampshire Health Record - now called CHIE (Care and Health Information Exchange)

There are 176 practices out of a possible 188 practices providing information to the Hampshire Health Record. The patient identifiable data is accessed regularly by hospital based clinicians as well as the ambulance service and individual GPs.  In addition the anonymised data is used for population based research,  hence why the coding of clinical records is so important.

The LMC has been supportive of CHIE during its development and evolution over the last 15 to 20 years because with the right governance we are able to share appropriate information and help our patients and potentially save lives.


5. Cameron Fund

The Cameron Fund is the GPs' own charity and the only medical benevolent charity which solely supports general practitioners and their dependents.

The charity provide support to current and retired GPs, as well as their families, in times of financial distress, whether through ill-health, disability, death or loss of employment. They help those who are already suffering from financial hardship and those who are facing it.

Sir James Cameron, Chairman of the GP Committee of the BMA in 1970, persuaded the Government to transfer money, left over from a scheme to help GPs finance practice premises, to a new charity which would support GPs and their dependents in times of poverty, hardship and distress. Sir James consented to the charity being named after him and acted as a trustee for many years, until just before his death in 1991.

Each year Wessex LMCs collect donations from GPs via the "Charity Levy" and this year we have collected £37,500 for the Cameron Fund, which I believe is the largest contribution from any LMC in the country.  I would just like to say a big thank you to all who have contributed. This charity does lots of good work and not infrequently we see and support GPs in difficulty and sometimes the result is that they face financial hardship and so we refer then to the Cameron Fund for help.

Wessex have always had strong links to the Cameron Fund with Dr Bob Button, my predecessor and Dr Stephen Linton a past Chair of Hampshire LMC  who serves as the Treasurer and Chair of the Fund.

For those who have contributed thank you, for those who haven't please consider doing so and look at their website - click here .



As promised I have attached the next two of Dr Paul Cundy's blogs on this matter - he is the GPC IT lead in this policy area.

Blog 4 is focused on Privacy Notices - I have attached a draft privacy notice for Direct Care, Screening and Risk stratification.

Blog 5 is all about text and e-mails.

GDPR webpage 

A hub page for GDPR information has now been launched on the BMA website .

This provides information on the regulation and hosts a suite of resources and blogs to help guide members. This page will be updated regularly as new guidance is published and more GP focussed information and resources will be added to this page soon.

The LMC has been in negotiation with LMC Law to provide a comprehensive package of training and documentation about GDPR and we will share this with you later this week.

7. Appraisals and Revalidation

For most GPs the annual cycle goes on in terms of your appraisal and every 5 years being Revalidated.  

I would like to remind you that to practice as a doctor in general practice, you must be registered with the GMC and also be on NHS England's Performers List.  To remain on the performers list you must successfully complete an annual peer appraisal, failure to do will mean you will be removed from the performers list.

It is therefore your responsibility that you have an appraisal every year and you should know where your Local Appraisal Service works from and who your Responsible Officer (RO) is.

Think about which address you use with the GMC, CCG, Appraisal Service and the RO,  if you move house or change surgery  I am sure you are good about informing your bank etc, well you should also inform the GMC, the Appraisal Service and the LMC.

If you are going to have an extended period out of your practice whether that be due to illness, maternity or you intend to have a sabbatical make sure you discuss your plans before you go. They will have lots of helpful advice and support to offer.


8. Reimbursement for phased return to work 

NHS England has now confirmed that practices must be reimbursed under the SFE for cover for GPs on phased return for sickness.

Reimbursement should include the cost of cover for all the sessions (up to the weekly ceiling) for which the GP is still absent, to maintain the normal GP cover.

NHS England local teams should now be talking with CCGs where issues have been raised to rectify any misinterpretation of the SFE.

Half of patients wait more than a week to see their GP 


9. Appointments with GPs

The Daily Mail reported this week that the number of patients unable to see their GP within a week has doubled in four years to around 50 per cent.

The newspaper said the root of the problem is understaffed surgeries unable to cope with an increasing, ageing population.

In response Dr Richard Vautrey, Chair of the GPC  commented that “under-resourced practices are struggling to cope with rising demand from a population with increasingly complex health needs. At the same time, too many practices are closing because GPs feel they are no longer able to offer the necessary safety and sustainability to their patients with the funding available.”

There is clearly widespread recognition of the challenges we face and these are impacting on patients and this is having an adverse effect on access for patients.  It is now important that we find solutions to address demand and increase capacity.

10. Cancer referrals block in bid to cut costs 

The Daily Mail also reported this week that a recent survey carried out by GP online revealed that half of GPs have been blocked from sending patients for urgent cancer scans.

About 45% of GPs said that at least one of their referrals had been blocked or downgraded by cost-cutting staff in the last year.

The GPC commented that “at a time when there is an increased focus on reducing any unnecessary delays in diagnosing cancer, it is a concern that there remains so much variability in the ability of GPs to access appropriate diagnostic services.”

There have been a number of media reports that is full of criticism aimed at  GPs because of the delay in diagnosing people who have cancers. 

To improve the early diagnosis of cancer there needs to be improved access to diagnostic tests and also referral pathways need to be quick without any barriers.

As a practice, I am sure you will look at all unexpected cancer diagnoses. 

Have you considered contacting your local McMillan GP or looked at their resources available for primary care - click here  for more details.

Best wishes


Dr Nigel Watson

Chief Executive

Wessex LMCs

Churchill House, 122-124 Hursley Rd

Chandler's Ford, Eastleigh

Hants. SO53 1JB (Registered Office)

Tel: 02380253874

Mobile: 07825173326


Attached file: 20180321PHEPGDHPVv0200.docx

Attached file: 4 Blog Four Privacy Notices.doc

Attached file: 5 Blog Five Texts and E-mails.doc

Attached file: Template Privacy Notice for Direct Care.doc

Attached file: Template Privacy Notice for National screening programs.doc

Attached file: Template Privacy Notice for risk stratification.doc

Attached file: 17-18 VI053_03 - NHS England PHE letter re shingles vaccine supply and timeframe restictions lift - FINAL - published.pdf

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Updated on 24 April 2018 905 views