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LMC Update December 2018

Date sent: Sunday 16 December 2018

December 2018 LMC Update

Firstly, apologies that you have not been bombarded with my normal Sunday morning missive about random topics that might be vaguely interesting to some of you. On second thoughts maybe, I should apologise for starting again following your welcome break from these! 

But I can reassure you that I will not mention Brexit!!!!

I have had one or two things that have rather dominated by life for the last few months, the one taking up most of my time has been the GP Partnership Review, more about that later.

We are fast approaching the end of another year it is a time for reflection. I am sure you are all preparing for Christmas and looking forward to celebrating with your family and friends. (Am I the only one who lacks inspiration and hates Christmas shopping?)

Christmas Carols are full of joy, happiness, celebrating the end of a year and looking forward to the next year with optimism and opportunity.

I look back on the last year and ask myself what I have achieved, but more importantly what have we achieved as a Local Medical Committee working hard on your behalf.

The core work of representing GPs, Practices and our profession is fundamental to all we do and takes up a lot of time. We also support and help individuals in a variety of ways that is dependent on their needs.

Many of you access our website at, where there is a considerable amount of useful information. In November, 3,400 users accessed information on our website, the majority in the Wessex area but there were over 750 users from London and 73 from overseas and the country with most hits is Russia with 20. We know that many GPs around the country access our website because to the amount of information that is available.

There are many services we provide or support as an LMC that are above and beyond our statutory duties and these include:

(more details later)

The big question is whether 2019 will be a pivotal year for general practice and its future?

In my view it will be, we will look back in 10 years’ time and see this a point in time that made a difference much as 1966 did with the GP Charter, 1990 with the change to the GP Contract and 2004 did with the introduction of nGMS.

I would like to thank all the staff at the LMC who have worked incredibly hard over the last year to ensure we provide the best possible service to you and your practice.


1. What did the LMC ever do for you?

Read more about the services that your LMC have developed to support GPs and Practice Managers in our area.

2. Cameron Fund Christmas Appeal

Many GPs contribute to this charity, as an LMC we support this as the only charity that we are aware of that is specifically for GPs and their families. Some of your colleagues and their families locally have been helped out by this fund.

3. GP Partnership Review

Hopefully the report and recommendations will be published early in the new year.

4. QOF business rules coding issues

Update from the GPC

5. Joint guidance on e-RS

Are you fed up with using proformas that don't make your life easier? Do you have to use a proforma? Read this section for the latest NHS England guidance.

6. Pensions update on total rewards statements (TRS)

Here is the latest information about this important area.

7. The NHS bans fax machines

What does this mean for you?

8. CPRD and UK BioBank 

Guidance from the GPC about data sharing with these respected research organisations.

9. GP practice list sizes increase by 50% since 2004

Merger packs and top tips from the LMC

10. Primary care medicine supply update

11. Sessional GPs - latest Newsletter

1. What did the LMC ever do for you?

There are many services we provide or support as an LMC that are above and beyond our statutory duties and these include:

Practice Manager Supporters

Practice Manager Supporters provide ad hoc advice and support to their practice manager colleagues, and offer learning opportunities to support Continuous Professional Development for PMs. The PM Supporters offer coaching and mentoring to new and experienced practice managers, and have specific training to enable them to appraise fellow practice managers. They offer support in person, via email or on the telephone.

Click here for more information 

Practice Manager Appraisals

The LMC has recognised the value of Practice/Business Managers to General Practices within Wessex and has supported an initiative to develop a system of appraisal for them. The Practice Managers' Supporters Scheme and the linked Appraisal Scheme have been based, with kind permission, on the scheme in Scotland, developed by Marion Foster.

Click here for more information 


GP Supporters

We are acutely aware of the increasing number of practices that are really struggling and finding it difficult to recruit new staff and sometimes short term locums, which inevitably means that the situation they find themselves in just gets worse and becomes impossible to turn around.

For many, what is needed is an experienced GP who can come in and assist for a short period of time to help the practice get back on its feet. The help needed will vary from practice to practice - seeing patients is a must, but assistance with leadership, providing the headspace to think about different ways of working, help to explore working at scale or even merging, plus the provision of advice on practice finance, governance etc. are all available too.

Wessex LMCs has recruited 10 experienced GPs to provide support to struggling practices both as hands on GPs and as GP leaders in order to ensure that both the clinical and managerial aspects of the practice are being fully examined prior to agreeing a plan towards sustainability.

Click here for more information

GP/Consultant Exchanges

Over a number of years the LMC has been involved in supporting and running a number of GP Consultant Exchange programmes including Dorset County Hospital, Dorchester, Queen Alexandra Hospital Portsmouth,  Basingstoke Hospital, St Mary's Hospital, Isle of Wight, Southampton General Hospital, Poole and Royal Bournemouth Hospitals.

These exchanges have been very successful with some hospitals now looking for a second round. They foster greater understanding, insuring a closer working relationship and building bridges between the professions.


Preparing for partnership

During the engagement for the partnership review, we heard repeatedly that GPs did want to consider partnerships but often this was not something GPs would look to take on immediately after finishing their training. They wanted to gain more experience and get a greater understanding of the risks and the benefits of GP partnership. So as part of the GP Partnership Review we developed a ‘Myth Buster’ for newly qualified GPs relating to GP Partnerships – click here for the document

This series of workshops for any post-CCT GPs, gives aspiring and new Partners the opportunity to learn from experts and share with peers what their expectations and fears may be. There will also be the opportunity for all the delegates to form local peer support groups following the end of the course to assist each other as their careers progress.


· Why Partnership?

· GMS & PMS contracts, the basics

· Finance

· Legal issues

· Premises

· Working with a practice manager

· Leadership & Management

· Skill-mix

· Time management

· Self-care, resilience and how to sustain yourself in a long-term partnership

· Career development

· Performance procedures

The programme runs over a number of months and offers ½ days. This was offered to all local GPs not knowing if the demand would be there, but we considered it worth taking that risk. Within a few days all the places were booked and we now have a waiting list of GPs who would like to attend the course. Due to the popularity of this programme we are intending to run a second set of workshops, so if you are interested add your name to the waiting list.

Next Generation GP

This started as a London based programme and was the inspiration of Dr Nish Manek, A GP Trainee and GP Fellow working with the Medical Director for Primary Care at NHS England. The aim was to gather a group of newly qualified GPs who were interested in leadership and provide a programme over a 9 month period to bring them together with the aim of ‘Energising, engaging and empowering’. The LMC was very supportive of the programme and supported the introduction of the programme in Wessex. The first cohort have completed the programme and we are about to support the 2nd cohort which will start in the New Year. If anyone doubts the potential, enthusiasm, commitment and engagement of younger GPs you just need to attend one of these meetings. We had over 60 GPs attending the events and the potential was there for all to witness.

LMC GP Leadership Fellows

I was aware that in Wessex we have had some GP Fellows for some time and these GPs have worked in general practice and had some funded time to work in a variety of roles including education and in CCGs.

As the LMC is heavily involved in Leadership, I submitted a bid to NHS to secure funding to have a GP leadership Fellow at the LMC. To my surprise we received funding to employ 3 GP Fellows for a year. We therefore recruited 3 GP Leadership Fellows from the cohort who attended the Next Generation GP and they will work with the LMC for 2 days a week for a year. The aim is to offer them the opportunity to develop their leadership skill and work on a number of initiatives that are of mutual benefit.

Dr Sarah Kay, Dr Julia Hempenstall and Dr Lizzie Madden joined the LMC recently and are already making an impact. They reconfirm what I already have worked out, that I was lucky to get into Medical School let alone qualify as a doctor (I still think they made a mistake and sent the offer letter to the wrong person) and if I was to apply now I would not get in. Sarah, Julia and Lizzie are early in their careers, yet have achieve so much already, in fact they made me feel a bit inadequate!

Triple E – a follow on from Next Generation GP

This is the ‘brainchild’ of our GP Leadership Fellows who are building on the great work that has been done through the Next Generation GP to offer an opportunity top move beyond that programme and continue the personal development. Why Triple E – it is the mantra of the Next Generation GP – ‘Engage, energise and empower’. You will hear more about this once the programme is developed a bit further.

Education and Training for Practice Managers and Practice staff

In the past few years, through the leadership of Louise Greenwood, the LMC has developed a comprehensive range of education and training events to support Practice Managers, Practice Nurses and other Practice staff. There are too many events to detail them individually but if you are interested – click here and view the range of events.

GP Education

In the past there has been quite a lot of educational events available for GPs with GP Tutors working for the Deanery organising refresher courses and other events, the Wessex Faculty of the RCGP offered a number of events as did the local hospitals. Because of the good provision of GP Education, the LMC decided to offer some training in areas where there were perceived gaps such as Safeguarding, basic life support etc.

As a result of the loss of GP Tutors and the need to diversify the way that education needs to be delivered the LMC has been working with the Wessex GP Education Trust (WGPET) to develop and promoted GP education. Recently the LMC received a grant from WGPET to employ a GP Lead to help develop GP education and Dr Helen O’Reilly was appointed to help us develop and promote this important area.

GP Support and Development Scheme

A core part of the role of Wessex LMCs is pastoral support. 

The LMC offers one to one support for GPs and Practice Managers. Like everyone they might face a range of situations from both challenges in the practice to those in the rest of life. The LMC aims to support and develop individuals as they progress through their careers to support your practice and YOU. 

Support for GPs - What is available

The Wessex LMCs GP Support and Development Scheme (GPSD) was launched on 28th November 2018. The scheme aims to help those who are facing some difficulties, whether caused by a negative or a positive situation in life but which is causing them to feel unsettled. 

The GPSD scheme is open to all GPs working as either a Partner or Salaried within our membership Practices located in Hampshire, IOW, Dorset, Wiltshire, Swindon, Bath & North East Somerset and the Channel Islands. 

For locum GPs practicing in our area we are able to offer membership at a cost of £50 per year which will enable access the GPSD scheme alongside many other great benefits - click here for more details

The scheme involves an initial confidential chat with a Medical Director. After this, depending on the needs, individualised advice, support and signposting will be offered. The LMC will also offer other potential avenues of support. These can include coaching, GP mentoring, GP Listener support, counselling and facilitation. Apart from the GP Listening service, which is free to access, the elements are co-funded with the individual. The LMC will contribute £50 per session for up to 6 sessions towards coaching or GP mentoring through the scheme and £25 per session for up to 6 sessions towards counselling. 

There are other services out there which may be able to offer free support and/or coaching and the LMC will endeavour to make people aware of the lowest cost option they are aware of if it is deemed an appropriate fit for the needs. 

The full description of services we offer please see GP Support & Development Scheme - Here to support your practice and you. These include:

The LMC will also provide a pastoral support role before, during and after performance issues, involving either NHS England and local performance procedures or the GMC. These processes can be extremely stressful and GPs need to know that they can turn to the LMC for confidential support whatever the problem. Those under performance procedures will not be eligible for the LMC subsidies but we will still endeavour to help support individuals to meet requirements set under the performance Procedures

To discuss whether GPSD is right for you simply email the LMC at our confidential email address 

Alternatively, contact the office on: Tel. 023 8025 3874 and ask for ‘Wessex GPSD’ to arrange for a discussion with a Medical Director at a mutually convenient time. 

The LMC team are used to dealing with highly confidential situations and information shared with us does not get shared outside of the LMC members of staff you discuss your situation with unless with the permission of the individual or if the re is a risk to self or others or GMC rules require otherwise. For mental health, distress, stress, burnout or addiction issues please see the GP Health service which is a national, confidential service for GPs – it is free to access for all GPs and GP trainees.    The NHS GP Health service will help GPs with:





2. Cameron Fund Christmas Appeal

Many practices in Wessex contribute to the Cameron Fund via a charity levy. This organisation was set up in the memory of a GP, Dr James Cameron, in 1970 and Wessex LMCs has enjoyed a close relationship with the charity for as number of years.

click here. To learn more about the Cameron Fund -

Cameron fund



3. GP Partnership Review

The Review is approaching the final stage and I am in the process of refining the recommendations which will be presented to the Secretary of State, Matt Hancock  and the Chief Executive of NHS England, Simon Stevens in the next couple of weeks and these will be published early in the New Year.

It has been a great honour and privilege to Chair the Review. I have had the opportunity to travel to all parts of England to meet GPs, visit practices and talk to a wide variety of organisations. I have visited many practices who despite the challenges are offering a very high quality service, are continuing to innovate and are recruiting new GPs both Partners and Salaried. I have also seen Practices where they have lost partners and are really struggling to attract enough GPs to provide a service to their patients.

The message i have heard which is loud and clear is:


Workload data

NHS Digital has published an important report last week outlining workload data about GP appointments. It is essential that we have good data to make the case for the increasing workload in general practice.

This is the first time that such detailed information has been collected, and it provides clear evidence of the huge workload delivered by practices on a daily basis. The report provides information on the following areas:

It shows that practices in England are booking more than a million appointments a day, many of which are taking place on the telephone and that practices are using a wide range of healthcare professionals to support their work. It also shows that the largest proportion of appointments are booked and attended on the same day and the majority take place within a week of booking.

While it does not include a wide range of tasks that GPs and their teams undertake on a daily basis, such as dealing with results and prescriptions, attending meetings and engaging in teaching, learning and development, and therefore does not show the totality of practice workload, it does provide definitive data which can help to underline the need for additional investment in to general practice.

Click here - to access the full report.


4. QOF business rules coding issues

Following the introduction of SNOMED (a clinical terminology that standardises terminology across different health locations) in 2018/19, NHS Digital’s business rules team has been converting and mapping the READ and CTV3 codes into SNOMED, which has proved difficult and complex. Although there was always an expectation that there would be some errors as there are each year with the baseline version of QOF, a larger number than previous years have been detected:

85 codes have been identified and queried from the v39 baseline QOF business rules from the total of 16,000+ that QOF uses (0.5% of all the codes).

Of these 85 queried codes 67 were incorrect and have been changed in v41 of the business rules

Those 67 codes impact on 12 registers from the 28 in QOF

It was therefore agreed that v40, the mid-year release, would not be implemented as new errors were continuing to be reported, and that v41 would be used instead. The revised v41 business rules will be published on the NHS Digital website next week and have already been distributed to suppliers. The affected registers are: Smoking, Dementia, Epilepsy, Heart failure, Asthma, Osteoarthritis, Stroke, CVD, AF and CHD.

NHS Digital has confirmed that no final QOF Payment will be affected. However, until mid-February there may be some slight errors in some reports, but practices should be able to identify which ones may be suspect by using the attached spreadsheet. 


5. Joint guidance on e-RS

The GPC has published joint guidance with NHS England on the electronic Referral System (e-RS).

Use of e-RS for practices is now a contractual requirement; the joint guidance provides information about its use and utility. 

Click here to read the full document.

I recently talked to a practice who estimated that they had over 400 proformas on their database. Proformas can be useful and help in the referral process, but all to often they have become too long and used as a way of collecting information that is not relevant to the GP but is relevant to the hospital. They save time for the hospital and not always the GP.  Since the use of e-RS became a contractual requirement the LMC has received an increasing number of complaints from practices about referrals made via e-RS being rejected because the hospitals proforma was not used or a box was not ticked on the proforma and therefore deemed not to have been complete properly. It is also very worrying that some of these rejected referrals are ones in the two week wait pathway.

There is a part of this NHS Engalnd national guidance that is clear, unambiguous and helpful - read below

Use of templates and pro-forma

If constructed with due diligence, templates and pro-forma can play an important role in ensuring concise and appropriate clinical information is exchanged between GPs and specialists. Using an integrated GP system, it is possible for e-RS to easily ‘pull’ data from GP records and quickly construct a referral ‘letter’, which saves time for GPs and/or their admin staff. These templated documents, which should be agreed locally between GPs, providers and CCGs, can be attached to the e-RS referral.

Since patients have the right to choose to be referred to any provider in the country for elective (as opposed to emergency) care and, therefore, may have several providers listed on their e-RS shortlist, referral templates and pro-forma should be as generic as possible and should be ‘owned’ by the referring or commissioning organisation, with the content having been agreed with local providers and endorsed by Local Medical Committees.   

Any provider of NHS services receiving a referral via e-RS, should accept clinical referral information in whatever format has been approved for use by the referring/commissioning organisation and endorsed by the responsible LMC. So long as adequate and appropriate clinical information has been added to the e-RS referral, providers should not refuse to accept a referral simply because it is not on their locally-branded template. 

We are discussing the problem with proformas with some local CCGs and hospitals and will discuss this will all CCGs and hospitals shortly.


6. Pensions update on total rewards statements (TRS)

Pensions Total Rewards Statements were updated thus week.  The records should be updated to 31 March 2017. The GPC  have been informed that in order for the TRS statement to be updated, the records need to be sequential. Thus, if a previous year’s records are missing, TRS cannot be updated beyond that. If your TRS is not up-to-date, it does not mean that your pension record is not. There are many reasons why your TRS may not be up-to-date and the independent pension expert currently contracted to look into PCSE’s processes, Price Water Coopers(PwC), is carrying out an investigation to determine where gaps lie in members’ records. We have been informed they will contact members if these are incomplete. This will hopefully help resolve them. A simple example would be that if you have added years, TRS will not be updated, in which case you can contact NHS pensions for a copy of your record.


7. Fax machine ‘ban’

The Secretary of State for Health and Social Care, Matt Hancock, announced last weekend that NHS trusts will be banned from buying fax machines from next year, with the aim of phasing them out entirely by 2020.

In response to this Richard Vautrey, Chair of GPC  said: “If the Government truly wants to overhaul IT to streamline communication in the NHS, it needs to ensure all systems across the health service are compatible and able to connect to each other properly. For this to happen in general practice, there must be real investment in IT infrastructure and support for practices as they seek to use new ways of working.”


8. CPRD and UK BioBank 

The GPC and LMC are aware that practices may recently have had communications about sharing their patient records with either or both UK BioBank and CPRD. Both are highly respected research organisations.

UK BioBank is a genomic study following a cohort of patients recruited up to 2010. On average each practice is likely to have 60 patients in the scheme. The entire patient record is shared. It is consent based. CPRD’s approach is to link large health data sources and then provide extracts for researchers in an anonymous or pseudonymous form. It currently has records on 35 million patients. It operates under an exemption for the common law duty of confidentiality and, for GDPR, probably relies on the processing for ‘research purposes’ lawful basis (this is a non-consented lawful basis). The entire practice patient database, except those who have opted out, is shared. In both schemes they will be accessing the records via the practices GPSoC core clinical supplier.

As the data controller of the patients’ records the practice has responsibilities under GDPR. Some of those responsibilities are clear and have already been communicated; updating Privacy Notices, Processing Registers and doing a DPIA (which must be done before any sharing takes place). Other aspects are not as clear because of the data controller / data processor relationships.

In addition, GP data controllers have responsibilities to ensure processing remains transparent whenever there is a change in data sharing arrangements. The GPC are in the process of clarifying with the ICO if this places any additional responsibilities on practices and hope to be able to offer definitive advice soon.  However in the meantime the GPC recommends that practices do not agree to either scheme unless they are clear that they have fully complied with their GDPR responsibilities.


9. GP practice list sizes increase by 50% since 2004

The Mail Online reported that the average list size of GP practices in England has risen by more than half since 2004, reaching 8,490 patients per practice this month. This figure was 5,891 in 2004, when the GMS contract came in.

The GPC reported that “Practices are gradually getting bigger as both the general population grows but also as some practices close or merge, leading to an expanded list size in those that remain… As practices increase in size it is vital that they remain embedded in local communities, maintaining the continuity of care that is so valued by patients.”

We believe there are more mergers taking place in Wessex than any other area of the country. Some are merging due to difficulty in recruiting and other because they believe they will be more resilience and less vulnerable in the future by doing this.

Click here for the top tips for mergers and the LMC merger pack.


10. Primary care medicine supply update

The Department of Health and Social Care supply issue update for November/December is attached.


11. Sessional GPs latest newsletter

Click here to access latest Newsletter 


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: Copy of FINALQOF_v41.0_changes_resulting_from_v39.0_queries.xlsx

Attached file: Supply issues update for Primary care December 2018.docx

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Updated on 16 December 2018 928 views