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LMC Email update 29th July 2018

Date sent: Sunday 29 July 2018

LMC Email update 29th July 2018

I thought the summer must be here with the amount of sunshine we have had and the lack of rain. Last week I began to realise the schools must have broken up as the roads were so much less busy and the trains that a couple of weeks ago only had standing room now had available seats.  But against that was that normally when the kids break up the weather turns and we get the wind and rain.

Well I am sitting here waiting to go and play golf and the weather has caught up with the school holidays - the rain and the wind has arrived, so I had better dig out my waterproofs.

I hope the really hot weather has not increased the patient demand in your practice too much and I hope you and your staff have coped with the 'overheating' in your surgery, I am sure many of us will have air conditioning on our partners meeting agenda, the trick here is to delay the discussion till about November and you will find it will save you quite a lot of money!!

Although the summer holidays are here and traditionally things have quietened down, this is not the case this year as still lots of things going on.

 

Contents:

1. Practice Managers - essential and all too often undervalued

PMs are so important to a successful practice, the LMC has undertaken a lot of work to support PMs which has now been recognised nationally.

2. Annual pay review for doctors in England announced

The outcome of the DDRB and the Government's response are now known.

3. Personalised care and Social Prescribing

Often referred to and mentioned in NHS documents but I wonder how much the average GPs knows about it and the potential benefits for their practice and patients?

4. Compensation for Capita failure

Have your problems with Capita ended?

5. Most GPs wouldn'’t consider working for online private services

More about the use of technology and the potential for a more flexible workforce.

6. Apprenticeships in England

Some helpful guidance produced by the BMA.

7. Survey – Unfairness in the 2015 NHS Pension Scheme

Help us to help you - the annulisation of hours for pensions is both unfair and a disincentive for part time workers.

8. The case for more investment in the community

More evidence in case you need it!

9. CQC recommendations on the management of controlled drugs in health and social care services

The latest guidance issued by CQC.

1. Practice Managers - essential and all too often undervalued

We are lucky in Wessex, we have many excellent practice managers who work tirelessly on behalf of their practice, patients and partners. A friend once told me that there was no such thing as luck, it is where opportunity meets ability. This is probably why that despite the major challenges in general practice, when visiting practices and meeting GPs, the LMC sees some great things happening and the potential, if resources were made available for so much more to be delivered - when great managers work with and have the support of their GPs, things happen!

Recently I received a document called 'CCG resource pack – Practice manager development' written by NHS England. In the GP Forward View NHS England it made a number of commitments to both support and fund training and development for practice managers.

I have attached the document for your interest. What I found particularly interesting were paragraphs 1.3d, 2.3a and 2.3c.

Please remember this is a document written by NHS England nationally and has been sent to all CCGs in England.

Paragraph 1.3a -  Appraisals.

Support has been provided to develop a scalable approach to training appraisers so that PMs can have a formative career development appraisal with a skilled peer. This has built on the work by Wessex Local Medical Committees.

Paragraph 2.3a - Training peer appraisers.

PMs often have quite an isolated working life, with few opportunities to receive support or encouragement from peers. Unlike GPs, most managers have no access to formative peer review or professional development planning. Wessex LMCs have developed a model for practice manager peer appraisals, based on successful work in Scotland. This includes a scalable approach to training appraisers, allowing for this kind of development support to be offered throughout England. Funding will be available through NHS England local teams to train and deploy appraisers throughout England. The goal is for every LMC area to have access to at least one trained appraiser.

Paragraph 2.3c - Coaching and mentoring.

The national Practice Manager survey indicated that PMs would benefit from coaching and mentoring focused on professional development. This allows them to receive tailored expert guidance on developing the manager's career and skills. Local funding will be available to facilitate this, for example through paying for appraisers’ time. Wessex LMCs have published videos explaining the benefits and practicalities of appraisals, coaching and mentoring for PMs: 

i. The value of appraisals: Click here for the YouTube video.

ii. Introduction to coaching and mentoring: Click here for the YouTube video.

iii. Jane’s story: Click here for the YouTube video.

iv. An example of coaching and mentoring: Click here for the YouTube video.

It is a great tribute to my team who work for the LMC to support and help you, that their work is recognised and championed and promoted across the country by NHS England.

I would particularly like to thanks Louise Greenwood, Carole Cusack, Lisa Harding and Michelle Lombardi who are responsible for so much of this work and keep reminding the rest of us of the importance of the manager to any successful practice.

 

2. Annual pay review for doctors in England announced

This week the Government announced its pay deal for general practice which was a 2% increase backdated to the 1st April with an additional 1% potentially available from April 2019 subject to contract reform.  Consultants were awarded 1.5%.

The Doctors and Dentists Review Body is an independent body that gathers evidence and then makes recommendations to Government on pay for all doctors in the UK. In the recent past the GPC has negotiated directly with Government, but this year the GPC included evidence to the DDRB and asked them to make a recommendation.

The DDRB listened to the evidence and expressed its concern about the workforce issues and made recommendations accordingly. Following the DDRB recommendations, the Government then makes a decision about an increase in pay, taking all doctors into account.

This year, the Government announced it is lifting the 1% pay cap for all public sector workers and so its decision was coordinated across all public sector workers (who are covered by various pay review bodies).

The  original agreement in the negotiations back in March was for an interim 1% pay uplift for all GPs and their staff and for any further uplift to be implemented based on the Government’s decision on the DDRB recommendations. 

From October, junior doctors will see a 2 per cent increase in pay consolidated, with consultants receiving 1.5 per cent with an additional 0.5 per cent linked to CEAs (clinical excellence awards) and associate specialist and specialty doctors will see a 3 per cent consolidated pay increase. However, pay increases for juniors, consultants and SAS doctors will not be backdated to April.

The DDRB had recommended a 2 per cent increase for juniors and consultants, and 3.5 per cent for SAS doctors and a 4 per cent increases for GPs.

The GPC Executive has been in direct contact with the Secretary of State and NHS England and  expressed very clearly the anger of the profession. The BMA has also responded to the announcement with a statement expressing the profession’s astonishment and Chaand Nagpaul, BMA Chair of Council, wrote to the Secretary of State for Health and Social Care requesting an urgent meeting to discuss what can be done to address the profession’s anger.

Richard Vautrey, GPC committee chair, commented on this in Pulse and GP online: “It is deeply concerning that the government has chosen not to honour the findings of its own independent pay review body across the entire NHS, bust specifically for GPs.

 

3. Personalised care and Social Prescribing

These are two terms which are used widely by commissioners and national bodies such as the Department of Health and Social Care and NHS England but when I talk to GPs they are unsure what the terms mean and certainly unclear of the potential benefits for patients and their practice.

Personalised care

Personalised care means empowering people to have greater choice and control over the way their health and care is delivered. It is fundamental to the changes the NHS is seeking to make over the next few years.  The result is better health and wellbeing for individuals, better quality and experience of care that is integrated and tailored around what really matters to them, and more sustainable NHS services.

My personal view is that this is an excellent aspiration but not quite what we are able to deliver because the system all too often does the opposite to this.

Social Prescribing 

Social prescribing is a means of enabling GPs and other frontline healthcare professionals to refer people to ‘services’ in their community instead of offering only medicalised solutions. Often the first point of referral is a link worker or ‘community connector’ who can talk to each person about the things that matter to them. Together they can co-produce a social prescription that will help to improve their health and wellbeing.

The community activities range from art classes to singing groups, from walking clubs to gardening, and to many other interest groups.  It is taking off across the country, particularly with people who are lonely or isolated; people with mild mental health issues who may be anxious or depressed; and, those who struggle to engage effectively with services.

It is also relevant to people with wider social issues such as poverty, debt, housing, relationship problems, all of which impact on their health and wellbeing.  Very often these people have frequent repeat visits to their doctor or to their local emergency department  – effectively trapping them in a ‘revolving door’ of services.

What’s happening already?

Nearly half of all clinical commissioning groups (CCGs) across England are investing in social prescribing programmes

1 in 5 GPs regularly refer patients to social prescribing and 40 per cent would refer if they had more information about available services (July 2017, GP Online Survey)

The General Practice Forward View has identified  10 high impact actions  to support practices to manage the demand on their services.

Personalising care around the needs of the individual is captured in the 10 actions, through commitment to supporting self care and to extending social prescribing.

Does this make a difference?

Social prescribing has been shown  to reduce GP consultation rates, A&E attendance, hospital stays, medication use, and social care.

The  University of Westminster led an evidence review, looking at the impact of social prescribing on demand for NHS Healthcare. They found an average of 28 per cent fewer GP consultations and 24% fewer A&E attendances, where social prescribing ‘connector’ services are working well.

It is also improving people’s health and wellbeing and is contributing to building stronger communities.

Next steps for 2018-19

NHS England  are encouraging all CCGs to work with their local partners to commission one-stop social prescribing connector schemes in their areas. Where this is working well, all GPs are able to refer people with wider needs.

They are developing an agreed model of social prescribing and a quality assurance framework to support it.

Local areas are being supported to complete a maturity matrix to benchmark their local schemes.

The GP Forward View talks about Care Navigators, sign poster and social prescribing - what does this mean to you?

There is no doubt that our receptionists are vital to the success of any practice. There has been training made available so that they can act as sign posters or care navigators - not all patients need to see a GP but are our receptionists aware of alternatives? It is estimated nearly 30% of GP appointments are avoidable and could be dealt with by someone else.

Some practices have got Care Navigators who have been employed by CCGs and are based in practices and they form an essential link between the practice, patients, the hospital, community services, local authority and the voluntary sector. We have such a person in my practice and they are very valuable. 

Social Prescribing needs more investment, promoting and a clearer description of what it can practically do for practices.

I believe there are two parts of social prescribing:

The new Health Secretary, Matt Hancock, has promised a £4.5m investment towards social prescribing schemes such as gardening or arts clubs, which could help practices employ staff to signpost patients to local organisations, or establish new social prescribing options. We await the detail of this offer.

 

4. Compensation for Capita failure

The Government's Public Accounts Committee has ordered NHS England to show how it has compensated GPs for the failures in the  outsourcing of primary care support services

I believe most practices have been affected in terms of the transportation of clinical records, the ordering of prescription pads etc, the delay in payment of money to practices, the difficulty in adding and removing GPs from the performers list and the errors in pension payments.  In addition the  inordinate length of time it has taken to correct these failures has been unacceptable.

I am keen to learn whether the issues described above still remain a problem in your practice. If so could you let me know and to what extent this is having an impact on your practice and the length of time you have been experiencing this?

Email: nigel.watson@wessexlmcs.org.uk.

 

5. Most GPs wouldn’t consider working for online private services

In a survey  undertaken by Pulse, the majority of 760 GPs said they would not consider working for an online private provider of general practice.

They believed it is a high risk to patient safety and a threat to core general practice.

However, other news outlets, including Mail Online, led with the fact one in four (25 per cent) of GPs said they would consider it.

Dr Krishna Kasaraneni, GPC Executive member commented: “What this survey shows is that the majority of GPs questioned clearly wish to continue working in the NHS providing face-to-face care to their patients, and that many have well-founded concerns over the ethics and safety of online models. However, as GPs face unmanageable workloads in the face of rising demand and chronic underfunding, doctors are understandably frustrated by this. Within this climate, private providers that are able to cherry-pick healthier, better-off, patients, and offer a more flexible workload to practitioners, may be an attractive option to some.Read the full article in Pulse

As I have indicated in my previous emails GPs and Practice Nurses are very experienced at telephone consultations and telephone triage and this is largely carried out without being able to view the patient and therefore the limitations include not being able to see the patient and pick up visual clues or examine the patients but you always have the option of bringing the patient in to be seen (some of us do this more than others - I know my conversion rate is significantly higher than others in my practice).

So in my view, the technology that allows you to see the patient and for them to see you may well enhance the telephone consultation but if carried out in a practice, still allows the clinician to bring the patient in to be examined. I believe it is the limitation of not having this option that puts many GPs off.

I talked to a couple of GPs who do work for online providers in the private sector, both said that they would prefer to work in the NHS and within a good team in a practice but with young families they needed the flexibility which few practices offer and the private provider included Indemnity cover within the contract and allowed them to work at times that fitted ion with family life so more work in term time and less in school holidays and the ability to work from home.

As part of the GP Partnership Review many GPs not just the younger ones are looking for greater flexibility in their working lives.  This is difficult to deliver in small practices but with the workforce crisis larger practices or groups of practice should look at offering such posts if they need greater capacity and the workers who want very part time work now may well be able to offer more hours in the future as their children get older.

 

6. Apprenticeships in England

The apprenticeship levy can be accessed by employers, including NHS Trusts and GP Practices in England, to help assist with the employment of apprentices by covering training and assessment costs. While only larger employers (those with a pay bill over 3 million) will be required to pay the levy, all employers (including GP practices), regardless of size, will be able to benefit from the fund.

The BMA has produced guidance on apprenticeships in England looking at what funding is currently available for employers, how the apprenticeship levy works and useful resources for those who are considering employing an apprentice. The guidance can be accessed here.

 

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

If you are in the 2015 Career Average Revalued Earnings scheme, the GPC would be really grateful if you could please to complete the short survey.

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

To get the best possible data, the GPC need as many GPs as possible – and the GPC's objective is to persuade the DHSC to acknowledge and remove the unfairness in the way the NHS Pension scheme currently operates.

 

8. The case for more investment in the community

I am sure I do not need to make the case to you for more investment in general practice, community services, community mental health and social care. In a recent report in the Cambridge News they reported that patients in Cambridge were admitted to hospital as an emergency nearly 11,000 times in a year for conditions that should not have needed hospital treatment.

The paper goes on to state, doctors’ groups said rising numbers of such admissions were due to cuts to social care and a lack of GP appointments, warning that without more funding the situation was unlikely to improve.

The average cost of a short stay for an emergency admission is about £1,000-2,000 and therefore the estimated annual cost for one large teaching hospital for patients who do not need hospital based care is between £11,000,000 and £22,000,000. All to often the media quote funding in the health service in terms of hip operation, numbers of consultants or nurses or another unit of hospital based cost - well at an average cost of a GP consultation being £20 the amount spent on unnecessary hospital admissions in one hospital catchment area could purchase between 500,000 to 1,000,000 GP appointments in one year. 

 

9. CQC recommendations on the management of controlled drugs in health and social care services


The CQC has released their annual report on controlled drugs including four new recommendations:

1. Prescribers should ask patients about their existing prescriptions and current medicines when prescribing controlled drugs. Where possible, prescribers should also inform the patient’s GP to make them aware of treatment to minimise the risk of overprescribing that could lead to harm.

2. Commissioners of health and care services should include the governance and reporting of concerns around controlled drugs as part of the commissioning and contracting arrangements so that these are not overlooked.

3. Healthcare professionals should keep their personal identification badges and passwords secure and report any losses as soon as possible to enable organisations to take the necessary action.

4. Health and care staff should consider regular monitoring and auditing arrangements for controlled drugs in the lower schedules, such as Schedules 4 and 5, to identify and take swift action on diversion.

Read the full CQC report here .

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: 2018-19 CCG resource pack - PMdev v1 060718.pdf

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Updated on 29 July 2018 277 views