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Wessex LMCs email update July 24th 2018

Date sent: Tuesday 24 July 2018

Email sent to all GPs and Practicer Managers in Wessex

I am sure you will be aware that we have a change in Secretary of State, with Jeremy Hunt moving to become the Foreign Secretary. He  has been the longest serving Secretary of State for Health and also gained Social Care to his Department. 

This is an extremely difficult role trying to deliver government policy at a time when there is significant financial constraint and rising demand within the NHS caused by a growing population and one which is ageing and presenting with more long term conditions. Having met with him on a few occasions and more recently being appointed by him to undertake the review of the partnership model of general practice, I have always found him to be deeply committed to the NHS, prepared to listen and concerned about patients. It is easy to be critical but there are a number of initiatives which he has championed such as a State Backed Indemnity scheme for all clinicians who work in primary care which will be a significant benefit general practice.  I wish him well in his new role.

It is worth mentioning that the Parliamentary Under Secretary  for Health (PUS for short - which is appropriate for health) with responsibility for primary care is a local MP whose constituency is Winchester, Steve Brine.  I have met Steve on a number of occasions to discuss both local and national issues. Steve has an excellent understanding of the issues that we face and has been very helpful in supporting the work we do as an LMC and is a strong advocate for primary care.

Turning to the new Secretary of State who is Matt Hancock an MP in West Suffolk and was the Culture and Media Secretary before taking up his new role.

In a speech last week he talked about his priorities being:

He has a technology background and so this was always going to be a key area of interest.

In a recent speech he spoke about general practice and said, "GPs need more assistance to tackle with their substantial workloads. There is currently a review of GP partnerships ongoing but I also want to see more training to those pharmacists based in GP surgeries and more staff to support them."

He concluded with a commitment "to make the investment in primary care and community pharmacies so people don’t need to go to hospital", but gave no specifics.

The Secretary of State has said that he has an App to consult with his GP because he is registered with an NHS practice that uses the Babylon technology. In his speech he said that this technology should be made available to all.

So is your practice ready, willing and able to use this technology if it were available at no cost to your practice?

In my view the problem is not the technology but the way it has distorted the delivery of general practice that is the problem that needs to be sorted.

Over the coming months the Government will have an opportunity to demonstrate how much it it values general practice when it announces the DDRB report (being announced this morning) and whether it supports its recommendations, the details of the State Backed Indemnity scheme and how that will be funded and how much is going to be invested in primary care when the future plans for the NHS are published in terms of investment of the additional money committed by the Government recently.

 

Contents

1. GP Partnership Review - quick update

2. NHS funding settlement briefing

An update on the £20.5bn that the NHS will receive but is it enough?

3. NHS e-Referral Service

What is happening on 1st October?

4. Update for practices in NHS Property Services and Community Health Partnerships premises

The LMC is all too aware of the difficulties some practices are having in this area currently.

 5. LMC Annual Conference

Have you booked your place yet? You could miss out on what will prove to be one of the most important conferences yet!

6. GMS and PMS regulations amendments

These have been agreed and now laid before Parliament.

7. The Potentially Avoidable Appointment Audit tool

A must for all practices - avoidable appointments could be a route to help workload.

8. New clinical roles

Some details from a national publication.

9. The Wessex Next Generation GPs

Really positive outcome of the programme designed to support the next generation of GP leaders.

10. Evidence Based Interventions consultation

The GPC has responded to this consultation which looks at treatments that have little clinical evidence to support them. It is being jointly sponsored by NHS England, NHS Commissioners, The Academy of Royal Colleges and NICE and many of their suggestions would be less restrictive than many CCGs currently operate.

11. Survey – Unfairness in the 2015 NHS Pension Scheme

If you are in the 2015 scheme please help us to help you.

12. Supply chain update July 2018

Some helpful national advice!

14. Advice about GPDR

Some practical advice from the GPC's IT lead

1. GP Partnership Review - quick update

I have now been leading the review for about 8 weeks. The role has been both interesting and challenging.  We have been talking to a huge number of GPs, Practice Managers, and many organisations. We have also visits a number of areas such as Plymouth and Devon, Humberside, Sunderland and Newcastle, Birmingham, Weymouth, the Isle of Wight,  Nottinghamshire and Yorkshire and in the coming months we have planned visits to Liverpool, Kent, London, the East Midlands, Suffolk, Cambridgeshire and Lancashire.

I have been hugely impressed at what general practice is currently delivering and the innovation that is taking place without adequate resources and support but also saddened where despite the best efforts of practices and GPs general practice is clearly in a critical state.

It will come as no surprise that the key issues identified by everyone are workload, workforce and risk. We are working on proposals that would start to address these areas and more.

If you want to keep up to date of what is going on in terms of the Partnership Review please look at the Wessex LMCs website and you will see my blog.

One thing I would like to clarify is that  my work at the LMC is continuing throughout the period of the review.  I am working in the Department of Health and Social Care for 2 days a week until the end of December.  Normally I work in my practice for 2 days a week and they have generously allowed me to take a sabbatical to complete the review.

I would also like to thank the fantastic team that we have at the LMC, including the Medical Directors, the Directors of Primary care and also all the other support staff who work so tirelessly for you and your practice.  They are invaluable in supporting me and the work I do and without them it would be impossible to have the time to complete the review.

 

2. NHS funding settlement briefing


On 18 June Government announced a long-term plan for the NHS.

This included a funding increase of 3.4% in real terms each year from 2019/20 to 2023/24, increasing the NHS England budget by £20.5b.

The BMA have published a briefing that discusses how this will impact health funding in the UK, suggests where it should be spent and highlights that it is not enough to cope with growing patient need. The BMA is calling for primary care to be one of the key areas that should be prioritised for this extra funding. 


Read the briefing


Visit the web page

 

Primary care - extract from the BMA's briefing document

General practice has faced a decade of underinvestment at a time when patient consultations are increasing, the population continues to grow, and patients are living longer with more complex health needs. A significant boost to general practice funding is an essential step towards making the NHS more sustainable in the longer term.

The commitments set out in the General Practice Forward View, to invest in general practice over the coming four years by at least £2.4 billion, remain wholly insufficient to either restore the share of NHS funding allocated to general practice to 2005/06 levels, or reach the BMA’s target of 11%.

Other key proposals for primary care, outlined in the BMA’s recent Saving General Practice, include proper investment in premises, IT infrastructure and administrative support; a sustainable indemnity package; and a workforce strategy that fosters collaborative multi-disciplinary general practice and community care.

Primary care must be one of the government’s key priorities for the 10-year plan for the NHS.

 

3. NHS e-Referral Service

 
The hospital  Standard Contract for 2018/19  in England requires the full use of the NHS e-Referral Service (eRS) for all consultant-led first outpatient appointments.

From 1 October 2018, providers will only be paid for activity resulting from referrals made through eRS.  £10m has been invested in the core funding for general practice to support this work.

Earlier this year the GPC secured agreement that the introduction of the eRS should be done in a supportive manner. Where a practice is having technical or other practical difficulties with eRS, it must agree a plan with the commissioner toward resolving the issues. Where the issues are not within the gift of the practice, it is for the commissioner to resolve. 

NHS England has issued  guidance for managing e-referrals  which is aimed at commissioners, practices and providers of acute consultant-led outpatient services which accept referrals from GP practices. The latest paper switch off (PSO) dates for NHS Trusts can be accessed here

 

4. Update for practices in NHS Property Services and Community Health Partnerships premises


The GPC continues to work on the ongoing issues with NHS Property Services (NHS PS) and Community Health Partnerships (CHP). They are aware that a written question was submitted to the Secretary of State about money owed to NHS PS and CHP by GPs.

We would like to remind  practices about our guidance on this issue. In respect of current charges, practices should only make payments to both the extent that they are both satisfied as to the legal basis upon which they are payable and their accuracy.

The LMC has been made aware that some practices are receiving the reimbursement from their CCG for the rent of the practice premises and are keeping this in their practice account and not paying their landlord. Please can I remind you that if the money you receive is a 'reimbursement' you need to ensure you pay the appropriate person or body even in the cases of premises if you do not have a current lease.

GPC England are aware that this issue is causing practices significant stress, and they would like to reassure you that GPC will stand with you in circumstances where, despite there being no legal basis to do so, NHS PS seek to enforce these charges.

To this regard, if NHS PS take action to enforce charges against you please let us know immediately by emailing gpcpremises@bma.org.uk

Further guidance and updates are available on our website, please follow this link .

 

5. LMC Annual Conference

General practice is at a crossroads, we have experienced several years of financial pressures on the NHS and the adverse consequences of this are all too visible in the current state of general practice.

But the big questions are - are things getting better and if not why not and can more be done to improve matters for general practice?

Over the last couple of years practice managers and GPs have repeatedly told us that the problems that they face include:

Some of these have been addressed nationally or are in the process of being addressed:

The LMC's annual conference takes place in November and with some much going on it is difficult to decide a theme for the day.  Following some discussion we felt that we should build on the issues that you have identified which include:

The day will aim to cover all these issues and more and will build on the work that is being undertaken by the GP Partnership Review of which I have the the privilege to chair - click here for more information.

Already 2/3 rd of the places are booked,  click here to book your place and avoid disappointment.

 

6. GMS and PMS regulations amendments


Following agreement in the last round of negotiations, the amendments to the GMS and PMS regulations in England have now been agreed and laid before Parliament. These have been released on  gov.uk  but will not come into force until 1 October 2018.

One of the main changes is to the section around removing a patient who is violent; these changes have been made following our concern that some practices were left vulnerable when patients with a recent history of violence registered with a new practice without the practice being aware of the situation. Such patients should instead be provided general practice services by a specially commissioned service. The GPC  was successful in agreeing some key changes to resolve this situation.

It has been agreed that a patient having a violent patient flag on their record, is reasonable grounds for a practice to refuse to register that patient (using paragraph 21 of part 2 of the regulations ‘refusal of applications for inclusion in the list’). It was  also agreed the new addition to the regulations that if a practice does register someone with a violent patient flag on their record, they may remove them immediately by giving notice to the Board. While the latter will come into effect in October, the former is an agreement around interpretation of the regulations and so can be implemented immediately. The GPC would also hope that commissioners would recognise the change coming in October and so may provide some scope for this too to be implemented right away.

 

7. The Potentially Avoidable Appointment Audit tool

NHS England has launched the new fully automated Potentially Avoidable Appointment Audit tool, which is free for all practices in England.

The audit is a simple tool for reviewing workload within practices and exploring how things might be managed differently in the future.

So far, more than 1,000 GPs across 400 practices have audited their appointments.

All practices can register for the audit by going to https://pcfaudit.co.uk/login.

To find out more about why practices are using the audit, results so far, changes they have made, and case studies, see here .

 

8. New clinical roles

A guide to new clinical roles has been published on the BMA website click here.

It has been designed to provide members with a broad outline of the new clinical roles that are emerging across the NHS, such as Physician Associates (PAs), Advanced Clinical Practitioners (ACPs) and Clinical Pharmacists. It also provides suggestions of further reading.

 

9. The Wessex Next Generation GPs

This programme ran from December 2017 to June 2018 was the brain child of Dr Nish Manek, who is a GP Trainee in Cambridgeshire and also a GP Fellow to Dr Arvind Madan, Deputy Medical Director NHS England and Director of Primary Care.

She initially established a group in London for younger GPs who were keen to learn, develop and experience leadership. Wessex LMCs thought that this was a good initiative and therefore agreed to sponsor up to 3 of our young GPs to attend. This experience was positive and following discussions with Nish who wanted to spread the programme, the LMC and Deanery agreed to work with her and a few local younger GPs to establish a Wessex programme.

The programme ran over the winter with up to 65 young GPs meeting monthly in an evening for a couple of hours. The gatherings we divided into two parts, firstly there was a presentation about a variety of topics given by a variety of established leaders, some local and some national, then one of the younger GPs interview a different leader about their experiences, lessons learned etc and gave the audience the opportunity to ask questions. The additional benefit was the networking that took place.

Having attended most of the meetings I have to say I was really inspired by the commitment, enthusiasm and dedication from the aspiring leaders.

But what did those who attended the programme get out of it and has it changed anything?

A total of 69 GPs attended the programme ranging from ST1 to some who were 6-7 years post CCT. Although the meetings we held near Winchester there was a wide geographical spread with one GP coming from Wales.

Before the programme the majority of those attending felt:

So, the big question is – did this programme make a difference?

The majority felt that the programme met their aims and would recommend it to others.

On completion of the programme those who attended were asked for their views and said:

This programme by any measurement has been a great success and is really encouraging for the future. The question now is what will happen to this group of leaders and how can they be supported further and what should be done in the future for others who aspire to lead?

 

10. Evidence Based Interventions consultation


NHS England has launched an  Evidence Based Interventions consultation, which looks at design principles of the programme, the interventions that should be targeted initially and proposed clinical criteria, including proposed new terms in the NHS Standard Contract.

This follows research evidence which showed that some or only effective when they are performed in specific circumstances. This is counterpart to the items that s hould not be routinely prescribed in primary care programme, which the BMA responded to.

The BMA will be responding to the evidence based interventions consultation (deadline 28 September), and GPC England will be feeding in to that response. For information on how to submit a response individually, see here .

 

11. Survey – Unfairness in the 2015 NHS Pension Scheme


The BMA is gathering data to find out whether certain groups of GPs are being discriminated against under the NHS Pension Scheme Regulations 2015.

The GPC and LMC believe that GPs who take breaks from work are ending up paying more without receiving any increase in their pension. This is happening through a method for calculating contributions called ‘annualisation’.

If you are in the 2015 Career Average Revalued Earnings scheme, please to complete a short survey .

If you are unsure whether you are in this scheme you can find out here .

To get the best possible data, we need as many GPs as possible to complete the survey. The GPC's objective is to persuade the Department of Health and Social Care to acknowledge and remove the unfairness in the way the NHS Pension scheme currently operates.

 

12. Supply chain update July 2018


The Department of Health and Social Care (DHSC) has published a supply chain update for primary care for July (attached).

In addition, the DHSC has informed us that they have been working with clinical experts to produce advice on the Priadel 520mg/5ml Liquid supply issue, due to the important nature of this medication and the issues around switching formulations / brands of lithium.

The advice is now available on the  Specialist Pharmacy services website . Sanofi are advising that the next supply of Priadel 520mg/5ml Liquid will be available mid-August.

 

14. GPDR - some helpful advice from Paul Cundy - IT Lead at GPC

If you think an individual may not understand what information would be disclosed to a third party who has made a subject access request on their behalf, you may send the response directly to the individual rather than to the third party. The individual may then choose to share the information with the third party after having had a chance to review it.

Found towards the bottom of ;

https://ico.org.uk/for-organisations/guide-to-the-general-data-protection-regulation-gdpr/individual-rights/right-of-access/

which is prefaced by this;

What about requests made on behalf of others?

The GDPR does not prevent an individual making a subject access request via a third party. Often, this will be a solicitor acting on behalf of a client, but it could simply be that an individual feels comfortable allowing someone else to act for them. In these cases, you need to be satisfied that the third party making the request is entitled to act on behalf of the individual, but it is the third party’s responsibility to provide evidence of this entitlement. This might be a written authority to make the request or it might be a more general power of attorney.

Please note the onus being on the 3rd party (the solicitor) to provide sufficient proof for the data controller to be satisfied.

Best wishes

Nigel

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

www.wessexlmcs.com

 

Attached file: Supply issues update for primary care July 2018.docx

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