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CEO Email Update - October 2018

Date sent: Sunday 21 October 2018

The NHS is at crucial point in its history - having completed 70 years we remain as one of the most treasured institutions in the country, valued by our patients  and communities.  It is always helpful look at the past and learn from it but we now face some very major challenges and therefore need to look forward and develop services that will ensure we can meet the demands of the future. This will inevitably mean change for us all and the key issue for me is whether we want a role in leading that change or whether we sit back and allow it to happen without our input?

It is clear to all that simply doing more of the same, expanding hospital based care at the expense of general practice, community services and mental health will not solve the problems that the NHS faces. But lets not throw out 'the baby with the bath water' general practice is evolving and changing all the time and I hope the GP partnership review will prove to be a pivotal point is changing the fortunes for general practice.


Click here for the GPC's latest GP Trainee Newsletter

Click here for the GPC's latest Sessional GPs Newsletter


1. Secretary of State's backing for general practice

A clear message of support for general practice.

2. Pension changes

A key issue in terms of annual and lifetime limits

3. GP Retention

This programme has now recruited close to 300 GPs, more needs to be done but this is will make a contribution.

4. Partnership review 

A short update for you

5. NHS standard contract tool kit for primary and secondary care

6. CQC provider Information collection (PIC) 

Some good news reducing the burden on practices.

7. CQC state of care report 2017/18

91% of practices are good or outstanding which is a tribute to general practice in England.

8. TPP data sharing

An update on the data sharing challenge that was causing some concern.

9. Locum protocol FAQs

Helpful information for all locums

10. GPs mental health

Support and help is there for those who need it.

11. Supplies of Hepatitis B vaccine - update

12. EpiPen supply issue and anaphylaxis packs

1. Secretary of State's backing for General Practice 

The new Secretary of State, Matt Hancock has made several speeches over the last few weeks that have specifically focused on general practice.  He has identified the importance of general practice to the NHS and our patient and has stated the important role that general practice has in terms of not only delivering care but also in terms of prevention and increased health and well-being.  

Click here  to see a video of the speech he gave at the Annual Meeting of the RCGP.

I can already hear some of you saying, so what, they all say that but never follow that through with practical help in terms of resources whether that is funding or additional people to deliver the care. So what is different now?

The Secretary of State for Health and Social Care  has committed to delivering increased investment in primary care and recommitted to many of the areas GPC England is currently working on including the state-backed GP indemnity scheme, exploring how the profession can work in primary care networks, the review of primary care premises, emerging IT innovations, and increasing the number of pharmacists working in General Practice. He has also confirmed that if a contract deal is agreed in England for 2019, GPs will receive an additional 1% in the baseline from April 2019 to bring the total consolidated award to 3%. This will be in addition to any funding agreement for 2019/20. He has also confirmed his support for the review of the GP Partnership model.


2. Pensions changes

The Secretary of State has responded to the GPC's  concerns about the impact of pension changes on GP retention. This has also been identified as a key issue by the GP Partnership Review.

Growing numbers of doctors are facing problems created by recent pension changes and this is having a real impact on workforce retention. One of these problems is that the Annual Allowance is currently set at £40,000 and tapers down to £10,000 for higher earners, and those who exceed the standard Annual Allowance limit or the reduced tapered Annual Allowance are subject to a tax charge.  This can either be made by paying the tax from savings via the tax return (taxed at the marginal tax rate) or by applying to use “scheme pays”. 

Further to several approaches made by the BMA, including a recent letter to the Chancellor of the Exchequer, NHS BSA has now agreed to permit the use of “voluntary scheme pays” to those who may have exceeded their tapered limit, but not necessarily the standard limit.  

Additionally, the requirement to have a tax charge of £2,000 or more is no longer required. This will be available from 2017/18 onwards and more details can be found  here

Whilst the BMA continues to challenge the application of annual allowance and other wider pensions issues, this change at least allows those members affected the option not to have to fund the charge from savings, investments or borrowings. 

We have updated our guide to annual pension allowance, which provides examples of how to calculate your annual allowance growth.  Read the guide here .

Click here and read the article published in GP Online recently.


3. GP retention scheme

The latest data shows that around 295 GPs across England had joined the  GP Retention scheme  to give them the flexible working options they need to enable them to remain in practice.

From having time to care for your family, wanting to reduce your hours as you approach retirement or to receive educational and development support after a period of absence, all GPs who are considering leaving General Practice and their employers should seriously consider applying to their CCG and joining this scheme.

Watch the GPC's  new video interview with two GPs explaining how the scheme has helped them to continue practising.


4. GP Partnership Review - update

This seems to have dominated my life for the last few months.  

It has been a real privilege to visit so many practices and talk to  GPs, Practice Nurses and Practice managers for all parts of England.

Last week I spoke at the Annual Conference of the RCGP in Glasgow and was able to engage with GPs from Wales, Scotland and Northern Ireland.

I have now published our interim report - which is available on the Department of Health and Social Care website - click here.   This aims to set out what we have done, the key issues and starts to develop the potential recommendations.  The document is just over 50 pages long and will take you no longer than 30 minutes to read.  This is important because this will influence the future not only of the partnership model but also primary care - so it is your future.

A number of you have emailed me with your comments, which has been helpful and I have used these to develop the proposals.

We are now entering the final stages of this process and will hope to publish the recommendations in a few weeks.

In summary there are 4 key areas:

1. Workload

2. Workforce

3. Risk

4. Status



The no 1 issue for most partnerships.

We need to expand the workforce to help meet the growing demand and this includes GPs, Nurses and new roles including pharmacists, MSK practitioners, mental health workers etc.

We also need to reduce unnecessary work - this includes the work relates to hospital care, the growing burden of everyone wanting a GP letter, technology to save you time rather than create barriers, help for practice managers with Capita and NHS PS (to resolve the many outstanding issues).

The development of primary care networks being based in a community, lead by general practice with others must support practices and not simply be seen as a way to support hospitals.

New QOF indicators for diabetes

QoF is an area that is seen to have too many indicators that have simply become a tick box exercise. NHS England is working with the GPC to reform QoF and this forms part of the contract negotiations for 2109/20.

NICE has published  new diabetes indicators  for consideration for inclusion in the Quality and Outcomes Framework (QOF). The GPC has been active in producing these new indicators which would support GPs to ensure that patients with diabetes receive care tailored to their individual circumstances.  These new NICE indicators will now be considered as part of the current negotiations between GPC England and NHS England.



We need to recruit more newly qualified GPs, make it easier for those who are working abroad to return to the UK to work without unnecessary barriers, and we need to create new roles for experienced GPs to prevent then leaving the profession. 

Two key questions for you -

if you are a GP who is aged 50 or more and considering leaving your partnership, what changes would be needed to retain your services?

If you are a GP in the middle of your career what would make you more likely to remain in general practice to the normal retirement age?

Practice nursing needs to be supported and developed allowing the greater involvement in the management of long term conditions and urgent care. 

In addition we need an expansion of the wider primary care team who will work with and support practices including pharmacists, MSK practitioners, mental health workers, care navigators etc.

I also believe community nursing should be based locally and fully integrated with general practice, which means they become accountable to the emerging primary care networks and we return to a situation where they are part of the primary care team working as one team.

There needs to be significant development of the role of a GP with an extended scope of practice working with and embedded in practices.



This is now seen as a major issue causing GPs to leave their partnerships prematurely and also preventing others joining partnerships.

The risks are seen as:


General practice need to be recognised by the NHS and the GMC as a specialty.

The general practice voice as a provider needs to be heard and have equal status to our hospital colleagues.

This starts with equity of funding for education and training, to having plans that not only include hospitals at STP level but look at the wider issues of communities and general practice.


5. NHS standard contract tool kit for primary and secondary care

NHS England has published a NHS standard contract implementation toolkit to improve working practices and patient experience between primary and secondary care. The toolkit contains a practical guide to support local systems to work together to implement these changes.

The BMA, along with other stakeholders, was involved in the development of this resource, which is aimed at reducing some of the avoidable transactional processes between primary and secondary care. Read the toolkit here .

The BMA has also produced guidance and resources to help improve the interface between primary and secondary care, including guidance on prescribing and referrals, and template letters to support GPs and CCGs. Access the resources here .


6. CQC provider Information collection (PIC) 

During the visits around the country taking to GPs, Practice Managers and others as part of the partnership review we heard repeatedly the disproportionate workload associated with regulation and particularly CQC. I was recently pleased to learn the Care Quality Commission (CQC) has been engaging with the GPC on the development of its annual provider information collection (PIC), which is to replace routine two-yearly inspections for practices rated good or outstanding. More details are available in the attached CQC communication.


7. CQC state of care report 2017/18

This was published earlier this week and reported that 91 % of GP practices were rated good in 2018, with a further 5 % rated outstanding, despite increased pressure on services.  These facts we highlighted by the Secretary of State in his address to the Annual Meeting of the RCGP in Scotland.

General practice has been found to be delivering the highest standard of care compared with other sectors, despite the workload pressures CQC themselves focus on. It is disappointing that this fact does not get highlighted to the general public by the Media who seem much more concerned with promoting negative stories. Generally the local Media is much more willing to engage in positive stories and particularly human interest aspects.

If your practice is one of the many good or outstanding practices, have you told your patients and celebrated this? Have you told your local newspaper or radio? Don't be shy ensure we promote general practice is a positive way.

This achievement is down to the hard work of you and your staff, and provides further evidence of the benefit of the partnership model of working. However we can't take this for granted for general practice to survive, develop and be sustainable there is a  need for additional support and investment in general practice and community based services, and this case is being made through the partnership review.


8. TPP data sharing

The Joint GP IT Committee (JGPITC), co-chaired by GPC and RCGP, has previously raised concerns regarding the sharing of patient records in TPP's SystemOne software. Interim statements were made in March and December 2017 and earlier this year advising GPs of progress being made to address those concerns. New functionalities were deployed and implemented earlier this year and are now fully embedded.

Consequently, the JGPITC is confident that GP Data Controllers using TPP SystemOne now have the tools they need to ensure that they comply with GDPR and DPA 2018, but which also support appropriate sharing of data for care. To that end the JGPCIT is of the view that the concerns it raised have been fully answered and considers the matter closed. This is the end result of significant collaborative work between the Office of the Information Commissioner, NHS England, NHS Digital, TPP, the RCGP and the GPC over the last 2 years. 


9. Locum protocol FAQs

Following a number of queries from GPs and LMCs about the way CCGs are interpreting the practice entitlements under the SFE, GPC has been engaging with NHS England to clarify the specific clauses relating to payments for locum covering sick leave and phased return to work. NHS England has now released some FAQs to clarify to both practices and CCGs.


10. GPs mental health

As an LMC we spend quite a lot of time supporting practices as well as individual GPs.  It has caused me some concern how over the last few years we have seen an increase in the number of GPs with mental health problems. Depression, anxiety disorders and addiction all appear to be more prevalent in GPs and some of this can be related to the increase in pressure that we work under not only the workload but the intensity, complexity as well as the risk associated with a society that wants to blame someone for everything.

GPs mental health and wellbeing is not only important to you and your family but it should be crucial to the NHS and our patients.

The BMA has published a new report on supporting doctors’ health and wellbeing at work. The report sets out the physical and mental health challenges faced by doctors, the benefits of a healthy workforce and makes recommendations for improvements. Read the report here.

NHS England also announced last week that a  new mental health support scheme  for all doctors working in the NHS would be launched. This builds on the existing  NHS GP Health Service , which was rolled out across England last year in response to GPC England’s campaigning, and which has now supported over 1500 GPs and trainees suffering from mental health concerns. This service is very valued by GPs, with a recent survey suggesting 93% were likely to recommend the service to others and 88% said it had a positive impact on their wellbeing.
The BMA has launched a survey to find out how doctors are feeling and coping, and whether you can get the support you need, so that we can lobby for the wellbeing doctors. Access the survey here

The BMA also provides a confidential, 24/7 counselling service and a peer support service, which can be accessed by calling 0330 123 1245. Visit for more info.


11. Supplies of Hepatitis B vaccine - update

The Department of Health and Social Care has informed the GPC that MSD has issued a customer letter advising that the adult presentation of the Hepatitis B vaccine, HBVAXPRO 10mcg, is likely to go out of stock very soon. Further deliveries are not expected until early 2020.

This is an ongoing issue and the DHSC has been working with GSK on to ensure they are able to support the market during this time. GSK have advised they have good supplies across all Hepatitis B vaccines. Providers should, therefore all be able to continue to access GSK stock (including the Engerix B adult presentations) in line with usual requirements.


12. EpiPen supply issue and anaphylaxis packs

The Department of Health and Social Care has informed the GPC that due to a number of queries received about anaphylaxis packs and issues with replenishing these due to the EpiPen supply issues, the attached communication has been produced to remind practices to help conserve adrenaline-auto-injectors. Note that similar communications have also been sent to dentists and schools.


In terms of adrenaline ampoule supply, please see current supply position:

Adrenaline 1:1000 1ml ampoules:

Martindale temporarily out of stock until end of October, some stock still available at wholesales

Hameln- supplies available and aware of Martindale’s out of stock period. They are able to support additional usage in primary and secondary care during this time.

Martindale have all of the following adrenaline products available:

Adrenaline Injection 1mg in 10ml (1 in 10,000) PRTC Pre-filled syringe

Adrenaline Injection 1 in 10000 10 X 1ml ampoule

Adrenaline Injection 1 in 10000 10 X 5ml ampoule

Adrenaline Injection 1 in 10000 10 X 10ml ampoule

Adrenaline Injection 1 in 1000 10 X 5ml ampoule

Adrenaline Injection 1 in 1000 10 X 5ml ampoule

Adrenaline Injection 1 in 1000 10 X 0.5ml ampoule


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: CQC strategy setting out new approach to the regulation of general practice.docx

Attached file: 20181009 - EpiPen Advice - NHSI Final.pdf

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Updated on 23 October 2018 753 views