PM Newsletter - August 2018
Date sent: Thursday 9 August 2018
We hope you are all having a brilliant summer and enjoying the sun. (Whoops, should have sent this 2 days ago!)
As usual, we have a lot of information and hopefully, helpful advice to impart so lets get to it!
Contract Negotiations 2018/19
Rather than bore you with the arguments around the Department of Health not accepting the full DDRB recommendations here are the actuals:
- Overall 2% pay uplift (1% already given on account) so 1% to come back dated to 1st April 2018
- Pay uplift expected to be awarded to all GPs (including salaried) and staff
- Global sum £87.92
- Out of hours deduction 4.87%
- QoF point £179.26
- Vaccinations and immunisations £10.06
PCSE - National Audit Office Report
As you are all very well aware, PCSE is not making any noticeable inroads into the delays, errors and adjustments needed across all sections from pensions and finance, to performers list and records.
Below is an update from the GPC:
The National Audit Office has released a report on NHS England's management of the PCSE contract with Capita. The report underlines how ill-prepared both NHS England and the outsourcing firm were when the programme was commissioned and illustrates Capita's failure to deliver backroom services to GP practices and individual GPs.
GPC has also launched a campaign asking for all practice staff members and individual GPs who have been negatively impacted by one or more of the service lines to sign the pledge. Despite GPC writing to NHSE numerous times to express disappointment that the operation of the service continues to fall short of an acceptable standard and calling for action to resolve the issues, this remains a daily challenge for practice and many sessional GPs. Therefore this campaign will be used to further demonstrate how far reaching the poor delivery of PCSE is on practice staff and show the Government the number of individuals demanding the service level be improved.
Please do sign the pledge but also provide details of your outstanding issues for Nigel, preferably using the attached template but don't worry if you've already emailed him, we'll tie it all up.
Subject Access Requests (SARs)
Please see below an update from the GPC on Subject Access Requests:
Following legal advice on the issue of solicitors charging a fee for SARs, we have updated our GDPR guidance with an FAQ which state:
Can we charge solicitors a fee for SARs?
Under GDPR, SARS are generally free of charge. Only if the SAR is considered to be ‘manifestly unfounded’ or ‘excessive’ can a ‘reasonable’ fee be charged. We don’t yet know when the circumstances when the ICO might consider it appropriate to charge a reasonable fee – but, in the BMA’s view, these circumstances are likely to be limited.
The updated fees guidance will also include additional information regarding the issue around what is regarded as ‘excessive’:
The GDPR does not provide more detail than this and as yet the ICO have not issued further guidance. We are in the process of seeking clarification from the ICO on what would constitute “manifestly unfounded or excessive” and will update this guidance once we have more details.
Interestingly, a firm of lawyers who have been holding GDPR workshops have advised that a charge can be made for postage and practices are having various levels of success around this. Some solicitors are offering to pay postage, others are agreeing to collect the print outs or have the patient collect them with others refusing point blank to pay. Until we get a definitive ruling its up to you whether you want to argue the point but I think offering the patient or solicitor to collect as a first line approach should be made and then ask for the postage. We're told if there is a refusal to collect or pay you will probably have to supply but at least you may receive some funding.
This of course does not apply to insurance companies who cannot request medical records under a SAR but only under the AMHR and so they must pay for your time, resources used and postage.
Finally, here at the LMC we are very much aware that these changes are causing serious concerns and we feed these to the GPC for their ongoing negotiations with Government.
Wessex LMCs Annual Conference
Our Annual Conference will be held on 28th November 2018 so do save the date. Further information will follow shortly, in the meantime please watch a short video clip outlining why you may find it useful to attend.
Digital First - Engagement exercise on payment implications of digital-first primary care
Please see below information that has been shared by NHS England:
Digital systems will be integral to a modern, efficient and responsive health service. Well-designed digital tools are already helping to provide care and services that are convenient for patients, efficient for the NHS and which get people the right care for them as quickly as possible.
However, we face a challenge to ensure that the way we commission, contract and pay for care keeps up with the opportunities digital innovation offers – ensuring that new technology is safely integrated into health and care pathways, whilst not unfairly destabilising existing services.
Today NHS England has set out a number of ways in which the payments for general practice may need to be updated to account for the emergence of digital-first access to primary care. The objective is to ensure that available resources are distributed in as fair a way as possible to GPs, reflecting the patients they serve.
Our analysis concludes that there are a number of ways in which the payments for general practice may need to be updated to account for the emergence of digital-first innovative primary care providers, related to:
- The rurality index payment;
- The London adjustment; and
- A reduction in the payment to practices for patients who live outside of the practice catchment area.
Further information about these proposals can be found at:
We would like to hear from as wide an audience as possible and would be grateful if you would promote this within your networks.
The findings of the engagement will inform the GP contract negotiations for 2019 – 2020 and beyond. Feedback is requested by 31 August, 2018 and we will ensure we send you further details when the public engagement begins.
Please email any questions about the report to email@example.com
As you will be aware, the LMC has opposed the out of area registration scheme since its first introduction and we now know that GP at Hand via Babylon software has registered thousands of fit (as in healthy!) patients who have subsequently been de-registered from their practice. Before registering patients for the scheme, GP at Hand and any other practices signed up to provide this, are supposed to ensure that these patients will have access to a home visiting service should one be required and we are advised this means pointing the patient to NHS 111 to give them the name of the practice(s) in their area providing a home visiting service. We are not convinced that all those registered will be covered in this way. If you are aware of any issues around this, please do let us know.
Patient Identifiable Data (PID)
In light of GDPR, please can we remind you not to include patient identifiable data in any emails that are sent to Wessex LMCs as these are not encrypted/secure emails and would be seen as a data breach by the ICO. Many thanks.
GMS Contract - Ready Reckoner
NHS Employers, on behalf and NHS England and the BMA’s General Practitioners Committee (GPC) has published a ready reckoner to support commissioners and practices in calculating the effect of the financial changes to the contract. http://www.nhsemployers.org/GMS201819
Skill Mix Matrix
Those of you who attended one of this years Practice Managers Conferences were given a preview of the Multidisciplinary Framework which we call the Skills Mix Matrix by Helene Irvine our Nurse Adviser. This shows the whole range of staff who could possibly work in a practice, from GPs and AHPs to paramedics and care navigators plus everything in between. It also provides information both on the competencies required to undertake certain work and what training is required to gain that competency together with where that may be available. Finally, it shows the cost of an individual health professional undertaking that work which can be compared with others of similar competencies. If you would like to know more then please click this link Skills Mix Matrix
The matrix is now based on 2018/19 pay rates and we will keep it up to date as things progress.
I'd just like to publicly thank Helene Irvine for the amount of work put into making this the incredible piece of work it is so much so that David Geddes, Director of Primary Care Commissioning at NHSE has adopted for use it in his own practice and the RCGP is considering validating it alongside our diagnostic tool.
LMC Practice Manager Committee Members
As you may be aware we have been undertaking elections for Practice Managers to sit on our committees. Please see below information on the outcome of these:
Elaine Korab - existing, re-stood (Hampshire)
Dan Ferrett - new (Hampshire)
Andy Mintram - new (East Dorset)
Nicky Watson - existing, re-stood (West Dorset)
Emma Bentley - resigned (East Dorset
Emmy Butcher - existing, re-stood (Wiltshire)
Caron Tremaine-Trucker - existing, re-stood (BaNES)
Robin Somers - new (Swindon)
LMC Buying Group
Please see below an update from the LMC Buying Group:
Firstly, a thank to those of you who responded about re-registering your details with the Buying Group ahead of the GDPR deadline. To date, 400 practices have re-registered.
In line with data protection we have removed any ‘personal data’ (i.e. the main contact’s name/email address) from the Buying Group’s database/website unless that person has completed the new consent form. For unregistered practices this means:
- They won’t have full access to the website which means they can’t view pricing or request quotes/order
- They also can’t access the new vacancy advertising service or the content/offers in the ‘Community’ section which will be launched over the summer
- They also won’t receive any updates from us and this does include the annual flu vaccine offers in the autumn
It also helps if there is a problem with, for example, this year’s flu vaccine orders/deliveries that we can easily contact them.
Practices can, of course, re-register their details with us at any time. It’s free and it’s a two-minute job. They can do this via this link:
https://form.jotformeu.com/73232425890355 or by going on to this page of the website and clicking on the Register button: https://www.lmcbuyinggroups.co.uk/members/. If you have practices that have never been part of the Buying Group or there is a new manager in post, then they can sign up the same way.
Update from LEaD
Please do have a look at our website for lots of courses that you can book up until Christmas https://www.wessexlmcs.com/events
We will be putting on more education for PMs and if you have any ideas for content – do let me know firstname.lastname@example.org
Finally – something to make you smile. Do spend a couple of moments looking at our filmed feedback from our June PM conference – what a lovely sunny day it was with such a wonderful group of positive PMs! https://www.youtube.com/watch?v=NCNOWXK9TF0&feature=youtu.be
GDPR & CQC
Please see below guidance from CQC and providers compliance with GDPR:
CQC will not be directly assessing or enforcing providers’ compliance with GDPR, nor is it our role to produce guidance for providers on GDPR. You can direct providers to the external sources of information to help promote their understanding and help them meet their own responsibilities.
Well-led organisations should understand their legal responsibilities. Their boards and senior managers should be seeking assurance that they are taking appropriate steps to comply. We will continue to follow our KLOEs to monitor and enforce compliance with our own regulations, including those relating to issues such as privacy and dignity, and the secure management of records.
It may also be useful to be aware of the following links to Nigel's Surgery:
GDPR awareness for all Staff
We are delighted that with the help of Adam Tuckett from CSU and our own Lisa Harding, we have updated our Information Governance Lunch and Learn Training Resource. This now includes GDPR. If you already have purchased access to the resource, you now can access the updated resource via our website here: https://www.wessexlmcs.com/lunchandlearn
If you have not already purchased this package, please do so here with a credit card or cheque. https://www.wessexlmcs.com/lunchandlearn. . Once you have paid, you can access all the resources here from our website. We recommend that if you download the resources ( instead of using them directly from the website) , that you do so afresh each time you run this session. We update these resources online and so if you always go to our website to download them, you can be sure that you are using the most up to date version.
Do contact me if you have any queries at all about this: email@example.com
CQC and Registration (Carole)
Given the number of practices in Wessex I was asked to sit on a working group with the GPC meeting with CQC to discuss registration in particular. Our first meeting was very productive and we agreed a number of actions including reducing the bureaucracy around the registration process and making it far more streamlined and online. I'm afraid we weren't able to prevent the need for all new partners and Registered Managers to have a CQC countersigned DBS check but I haven't given up on that one yet - the best thing they could offer was more local post offices but they will look at the update (transportable) DBS to see if it fits with their legislation!
One fact that I hadn't really taken on board previously is that CQC sees Registration as the first part of the overall inspection and rating process and it's therefore vital that practices maintain an accurate registration with them. Who knew?
It's also worth noting that NHS England has advised that all new entrants to the Performers list from August this year will be mandated to apply for the DBS update (transportable) certificate which should alleviate all issues around locums, salaried and sessional GPs over time. The LMC does promote this already to GPs and nurses requesting checks via our service and at a cost to the health professional of £13 per annum it's really worthwhile having.
CQC - feedback on factual accuracy process
CQC has sent the following:
Feedback from providers and inspectors shows that our factual accuracy process needs to be improved. We want to improve the efficiency, clarity and effectiveness of the process, and we need your help to do this.
Providers and inspectors have told us that the factual accuracy process is frustrating because:
- The guidance does not give providers the information they need to understand the purpose and scope of the factual accuracy process, so submissions made sometimes overlap with other processes such as complaints.
- Providers can make more than one submission and submit large amounts of information, often not using the CQC Template provided. This is very time consuming for providers, and the information provided is not always relevant to the factual accuracy process.
This increases processing time for inspectors, results in inconsistent responses, and delays to report publication.
We want to improve the factual accuracy process to help providers make submissions that are appropriate, effective and concise. This will help improve the timeliness of report publication, saving providers and CQC time and resources and ensure a better service for the public.
We are at the beginning of making these improvements and want your views on what the key issues we need to address are, and what we could change to improve the process.
Please visit the online community for more information and to share your views: https://communities.cqc.org.uk/provider/document-for-review/help-us-improve-our-factual-accuracy-process. You will need to be registered with the community to share feedback and can sign up here: https://communities.cqc.org.uk/provider/user/register.
The deadline for responses in Friday 31 August.
In addition to submitting comments through CQC’s online community (as set out above), feedback can also be sent directly to firstname.lastname@example.org
Go on - you know you want to! The LMC will be submitting some feedback that's for sure!
This one seems to be coming up a bit lately so just to clarify, anyone serving a prison sentence of less than 2 years (including consecutive sentences) remains registered with their GP and are only removed if their sentence is more than 2 years.
The prison service may ask for a summary print out of the record which includes any medication, allergies and long term conditions which should be provided in the interests of patient safety but anything more than that can be charged for.
From PSO_3050 - Continuity of healthcare for prisoners
2.1 When a prisoner enters reception a new clinical record is created (see 2.5). Efforts should be made to retrieve any information required from the prisoner's GP or other relevant service he/she has recently been in contact with. The prisoner's explicit consent should be obtained before doing this, although in exceptional circumstances information may be requested and disclosed without consent. For further information on access to information see PSI 25/2002 The Protection and Use of Confidential Health Information.
As many of you will know, if you sign up to PharmOutcomes any patient given the flu vaccine by a pharmacist is entered on the PharmOutcome site and an electronic notification sent to the practice. This saves a huge amount of work for practices so, if you're not already signed up you may wish to consider this. Click on this link.
Items of Interest
Vaccination Status of Staff - As part of CQC practices need to keep a log of the vaccination status of all staff which reflects the relevant vaccinations for their roles.
This is particularly important as there has recently been a case of measles which has highlighted a lack of awareness of MMR status for staff.
Since 26th January 2018 a total of 75 suspected cases of measles have been reported, with 28 confirmed, 18 probable and 29 possible.
All adults are eligible for 2 doses of MMR (this includes those born before 1970 if there is no history of measles) and can be obtained from their own GP practice. Practices are able to claim for these through the CQRS extraction.
Please see a link below which provides information on the vaccinations that practice staff, dependent on their roles are required to be offered:
Nursing Associates - If you have an HCA who is keen to go down the Nursing Associate route, they can contact Solent University to express an interest in the 2019 intake.
Registered Nurse Apprenticeship Degree - Please see an update from Annette Farrell from HEE:
Solent University has had their Registered Nurse Apprenticeship Degree (RNAD) programme approved by the NMC and is now open to applications. Please be advised that all HCAs from GP Practices, ex(pressions of interest, need to first come via myself and Matt Freeman (email addresses below) from Solent University. Matt will need to talk to the individual practices before proceeding with applications, as Matt will be responsible for drawing up the individual learning contracts with the GP Practice and HCA. It is also vital that the HCA and employer understand the commitments required to the programme and placements.
If I am sending this email to you it is because I am hoping that you can disseminate it to local GP Practices, that you are a manager with an interest in supporting staff to access this RNAD or that you are a HCA wishing to apply for the RNAD. Please remember that apprenticeship applications all have to have full support from employers before they can proceed.
If you require information on the entry requirements for this programme or information about the course, then visit the universities website https://www.solent.ac.uk/courses/undergraduate/adult-nursing-practice-bsc?year=2018
There is also a page about apprenticeships https://www.solent.ac.uk/courses/info/higher-degree-apprenticeships
There is a tight time scale for applications, interviews will be during August 2018 and the programme commences September 2018.
Accurx - EMIS practices only
Jennie Dock from Hedge End Medical Centre & Adrian Wise from Charlton Hill Surgery have both been using this product, which currently is only available to EMIS practices. We believe there is no cost for the basic version. It allows practices to send SMS messages to patients instantly and codes back what you have sent into the records.
Jennie provided examples of how they are using this; asking patients to make a repeat blood test appointment, invite a number of patients who are on a waiting list for the steroid injection clinic to name but a few.
It has an API with EMIS, and it’s gone through all the IG processes.
Please see their website for further information: https://www.accurx.com/chainsms
Finally, we are looking to hold some federation/collaborative working type workshops in the not too distant future to cover all of those uncertain bits around sub-contracting, lead practice, VAT , CQC registration etc etc so keep your eyes open for your invitation.
Please don't hesitate to let us know if we can help in any way.
Carole, Lisa and Michelle
Directors of Primary Care, Wessex LMCs.