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LMC Email update 28th May 2018

Date sent: Monday 28 May 2018

Email sent by Wessex LMCs, on Monday, 28th May 2018

Last Friday I saw my last patient as a GP, as I am about to have a sabbatical, returning to my practice once I have completed the GP Partnership Review in December.  

It is an odd feeling telling patients that they would have to see an alternative GP for the next few month. It does make you realise how important this relationship is to our patients and how much they value it.

I will miss the patients but not the mountain of paperwork, results etc.

It will focus my mind on trying to find some long term solution to the problems we face of recruitment and retention, workload and workforce and for this to be more than just words, there needs to be impact within and for practices.

The LMC is continuing with a programme of GP Consultant Exchange - now been implemented in 6 hospitals locally and has proved to be enormously popular both with GPs and Consultants.  It is helping to break down some of the barriers between primary care and hospitals.  Perhaps all  doctors in training should have to spend a day every so often in general practice as this could form an important part of their training.

Recently the Hampshire and Isle of Wight STP had a two day meeting to discuss the future of local services.  I am please to report that this meeting was very positive and agreed that there needed to be a greater focus of primary care and the delivery of care outside hospital.  This will require resources and true integration between various services and general practice.

The culture in a practice is important in terms of how efficient the practice is at delivering care and also how valued those who work within the practice feel. It is becoming increasingly important for practices to work together and feel part of a larger team.  In the New Forest for the past 15 years or so the 17 practices get together for an annual Inter practice quiz.  This has proved to be hugely popular with the staff and gets different practices together with a competitive spirit  but essentially is seen as a bit of fun and a good opportunity to socialise.   We held the annual quiz recently with close to 100 GPs, Practice Managers, Practice Nurses and other staff making up the individual Practice Teams. 



1. NHS - 70 years old

2. GP Partnership Review

3. Practice Managers - the bedrock of general practice

4. Medical Workforce in the UK

5. National Audit Office report on PCSE

6. GPs struggle to offer routine appointments

7. Fewer GPs working in deprived areas

8. New national data opt-out

9. Diamorphine supply issue

10. Hospital contract guidance – onward referral


1. NHS - 70 years old

The NHS celebrates its 70th birthday on the 5th July and is acknowledged as one of the general publics most treasured institutions.

The first contact that most patients have with the NHS is in Primary Care and this  provides  the front door of the health service.

In the 70 years since the NHS was formed, the health needs of the population have changed with a greater number of people living longer, many with complex health needs.

Services are under increasing pressure and to meet these demands, general practice  has evolved and continues to change to provide high quality services for patients now and in the future.

Click here to see a "Then and now: Brief history of general practice and pharmacy" video .  

Share this link with you patients -

As GPs we have much to celebrate and looking ahead there is a very delicate balance in terms of identifying the challenges we face, addressing these and seeking solutions and not being so negative about the future that we ensure we have a self fulfilling philosophy.

It is in everyone's best interest that general practice not only survives but thrives, from patients to the general public, from people who work in general practice to hospital who cannot function without us and finally for Politician who need to recognise that international evidence repeatedly reports that the NHS is one of the most cost effective healthcare systems in the world and that the reason for this is the structure of the NHS and the place that general practice plays in that.

Someone recently wrote to me and said

      We need time to care, 

      resources to treat, 

      social services to support, 

      transformation to collaborate and survive, 

      hope where there is despair. 

      Give us the funding and we will give you great general practice

This really struck me as it described in a few lines what I think we all sign up to.


2. GP Partnership Review

Following my recent email I would like to thank all of you who sent me emails congratulating me on my appointment as the Independent Chair of this review. As I said it is a great honour to be asked to lead the review but I am also all too well aware of the responsibility this comes with and the challenges that I will face over the coming months. 

I would also like to thank all of those who sent me their personal views on what actions would make a difference, they have been very helpful and have be used to start to formulate our ideas.

The end point of this process will be to produce a report with the findings and recommendations.

The review has an oversight Board which includes the Chair of the GPC and RCGP, the GP who is the Director of Primary Care in NHS England and senior Managers from both NHS England and the Department of Health and Social Care.

We are finalising a reference group to help us with the review which includes representatives from a number of external organisations and also a number of people whose main job is working in a practice.

I have been asked several times by GPs if I believe the review is something that the Secretary of State really wants or is this just  a way of appeasing the profession at a difficult time?

The Government recognises that the NHS is facing major problems at the present time and that the solution is not to simply continue to invest more and more into hospital based care.  The only alternative to this is to ensure that the resources are made available in communities to support and look after the local population and this means investing more into community services and general practice. It also means that practices will need to work more closely together and there needs to be true integration with community services.

Currently there are discussions going on about the potential for 10 years of increased funding for the NHS - potentially an additional 4% year on year for the next 10 years.

We wait to hear about the outcome of negotiations relating to the the introduction of a State backed Indemnity scheme in April 2019.

All these factors place general practice not only at the heart at of the NHS but the potential solution to many of the challenges.

I would not have accepted to role if I felt it was just an appeasement to the profession and early indications are that it is far from this.

I am due to start the role on 1st June and complete the report by the end of December.

I have already attended several meetings to establish the Project Board and the Reference Group. I have had meetings with the No 10 Health Policy advisor and Simon Stevens the Chief Executive of NHS England.  

For the duration of this review I will continue to work for the LMC but the two days a week when I am working on the review I will be based in the Department of Health and Social Care (DHSC)  and 4 excellent senior people from the DHSC have already been appointed to support me directly in the review with additional support coming from NHS England, the RCGP and the GPC. 

We aim to visit a number of areas in the country over the next few weeks to look at where the problems are most acute but also look at places where solutions have been found and to meet local people who work in general practice to hear their views about what the problems are and potential solutions.  

We will in addition ask you all for your input via a survey and also make use of social media.

So I believe this is a real opportunity at this point in time to ensure that general practice takes its rightful place as the 'Jewel in the Crown of the NHS'  but to achieve this I will need your help and support.


3. Practice Managers - the bedrock of general practice

Last week the LMC held the first of two Practice Manager conference - this one was in Swindon and in a couple of weeks time our second one will take place in Hampshire.

It was a great day and I would like to thank the team at the LMC who did a fantastic job putting the event together and ensuring it was a very successful day.

What impressed me most was the knowledge, enthusiasm, committment and dedication of all the Practice Managers who attended on that day.

As partners I think we sometimes forget how important our Practice Managers are, do we take the time to say well done, great job or is the expectation that they are superhuman and exempt from the pressures we feel every day?

As an LMC we work closely with Practice Managers, and have 3 Directors of Primary Care who attend many Practice Manager groups and also work directly with Practice Managers.  The LMC have funded a number of PM Supporters who help new and established Practice Managers (many of the PM supporters attended the Conference and helped facilitate the group working).

Take a moment to think about what you and your practice do to support your Practice Manager.


4. Medical Workforce in the UK

The NHS employs over 1.7 million people in the UK, making it one of the world's biggest employers. This includes around 190,000 doctors.

The BMA has published new data on the  Medical Workforce in the UK . Here you can find the numbers of doctors in the UK and each nation, the key trends over the past 10 years and the issues around the quality of available workforce data. 

In England, figures show a decrease in the number of FTE GPs of all types, over the past seven years, a decrease  reflecting the crisis in the general practice workforce.The number of salaried GPs is increasing while the number of GP partners is decreasing.

The trends in the English medical workforce can be seen here.

The number of full time equivalent (FTE) consultants has increased from 35010 to 46130 in the period 2009 to 2017 and over the same period the number of FTE GPs (excluding locums) has decreased from 36085 to 33036.  This means the consultant numbers have increased by 24% where as the GP numbers working in practices have fallen by 8.5%.

This data shows the extent of the challenge that we face in general practice and hence the urgency to confirm why the partnership model has become less popular and also to find positive solutions to "revitalise the partnership model of general practice"


5. National Audit Office report on PCSE

Following the publication of the  National Audit Office report last week about NHS England’s management of the Primary Care Support Services contract with Capita, the issue was debated in Parliament on Wednesday. Read the transcript of the PMQs  here .

Read the  BMA press release  on the NAO report.


6. GPs struggle to offer routine appointments 

Pulse  investigation suggests one in six GPs are under such pressure they have resorted to halting routine appointments or limiting appointments to ‘emergency only’ at some point in the last 12 months.

The survey of 800 doctors found some practices are not able to offer appointments for a month, and will screen every patient who calls by telephone to assess if they need. In response to this, Richard Vautrey, the Chair of GPC  commented: “This is further evidence of the pressures practices are under, with growing demands for appointments not being matched with an ability to provide them due to the continuing recruitment and retention crisis in general practice.”

The problem for many practices is that demand cannot be meet with the current workforce and hence why the review into the partnership model is urgent and needs to make recommendations that benefit patients and front line staff.  


7. Fewer GPs working in deprived areas

New research spearheaded by Frank Field MP has revealed that fewer GPs are choosing to work in poorer areas compared with those joining surgeries that look after wealthier populations.

Commenting on the findings, Richard Vautrey said that instead of “short-term fixes” general practice needs “sustained significant investment, enabling all practices to recruit sufficient GPs and other staff”. He also said that “The difficulties of recruiting to areas of deprivation, particularly those away from large cities, has been compounded by the historical lack of investment in infrastructure, such as premises, making it harder to deliver good quality care and therefore is a less attractive option for younger GPs.”

In Wessex we have had particular difficulties in Swindon, Gosport, Southampton, Bournemouth and on the Isle of Wight but nowhere has escaped the pressure with many rural practices finding it difficult to recruit.


8. New national data opt-out

NHS Digital has announced the introduction of a new national data opt-out and conversion of type 2 objections, enabling patients to make a choice about whether their data can be used for research and planning purposes. The type 2 objection means that a patient’s confidential information should not be shared for purposes beyond their individual care. NHS Digital has written to practices to explain that they will automatically converting patients’ existing type 2 objections to the new opt-out from 25 May 2018. Every patient aged 13 or over with a type 2 objection recorded will receive a personal letter after 29 May, explaining the change, and a handout explaining the national data opt-out. Patients will not have to take any action and this will not affect the way that their information is used. 

Practices will not be able to see the national data opt-out in the patient’s electronic record as they will be held on the NHS Spine and will not be updated in GP systems. The type 2 objection codes will still be available in GP systems after 25 May 2018 but must not be used from the 1 October 2018 as NHS Digital will no longer continue to process and convert them.

Some patients may also have a type 1 objection registered on their electronic record, which should continue to be respected. The type 1 objection prevents the sharing of a patient’s personal confidential information held by the GP practice for purposes beyond the patient’s individual care. It remains the responsibility of the practice to ensure these are applied where relevant, except for General Practice Extraction Service (GPES) collections where the type 1 objection will be applied automatically unless instructed to the contrary by Direction.

NHS Digital will be sending practices a pack of patient communication materials to help explain the changes, and have developed a checklist of actions that practices might want to take, available herePlease see this link  for more detailed questions and answers.


9. Diamorphine supply issue

The Department of Health and Social Care (DHSC) and NHS England have been made aware of a manufacturing issue from one of their suppliers of Diamorphine 5mg and 10mg injection. Recently Accord’s plant in Germany experienced quality issues and the DHSC is working closely with them, regulators, and others to resolve these issues. 

Based on current usage and remaining stock, there is the potential for supplies of Diamorphine 5mg to be depleted week commencing 4 June and diamorphine 10mg injection week commencing 11 June. Further supplies are currently expected the week commencing 28 June. The DHSC is working closely with the remaining supplier, Wockhardt, to secure further supplies for the UK market from July, and working with Accord to resolve the issues. They are also working with national clinical leads and specialists to discuss alternatives. The UKMi has published guidance to support this supply issue, available here

The recommended alternative is morphine 10mg injection. Further information in the Patient Safety Alert on high dose morphine and diamorphine is available  here . NHS England’s patient information leaflet to support this medicine supply issue is attached.


10. Hospital contract guidance – onward referral

I am sure your will all remember the details of the new NHS hospital contracts that place new requirement on hospitals:

- That the results of investigations requested by hospital clinicians should be communicated by the hospital directly to patients. 

- That hospitals should directly liaise with patients should they miss an outpatient appointment rather than ask GPs to re-refer. 

- That hospitals should make direct internal referrals to another department or clinician for a related medical problem rather than send the patient back to the GP for a new referral. 

- Hospitals to issue Fit Notes, covering the full period until the date by which it is anticipated that the patient will have recovered. 

- Hospital Trusts to respond to patient queries for matters relating to their care rather than asking the patient to contact their GP. 

- Hospitals must not transfer management under shared care unless with prior agreement with the GP. 

- Hospital clinic letters to be received by the GP within 1 within 7 days from 1 April 2018. T

- Issuing medication following outpatient attendance at least sufficient to meet the patient’s immediate clinical needs until their GP receives the relevant clinic letter and can prescribe accordingly. 

New guidance on onward referral has been published by the Academy of Medical Royal Colleges.. Changes to the contract in 2016 allowed for onward referral of patients by secondary care clinicians, in certain situations, rather than having to always require referral back to the GP. The guidance is designed to support doctors locally in applying the change appropriately. As a reminder, new guidance was also published recently on the  responsibility for prescribing and principles for shared care . All guidance can be found on the  BMA website.

The GPC is aware that implementation of the contract measures is still very variable and we will continue to press for improvement. They are currently working with NHS England on a contract implementation toolkit for CCGs, who will be encouraged to work with LMCs and providers.

I hope you all had a good Bamk Holiday and enjoyed the weather.

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: Patient information - diamorphine FINAL.docx

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Updated on 28 May 2018 826 views