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LMC Email update June 2014

Date sent: Sunday 22 June 2014

Email sent by Wessex LMCs to all GPs and Practice Managers, on 20/06/2014.

Over the last few weeks I have spent much more time defending general practice and promoting the strengths of  the generalist specialist (AKA a GP) and the system of a registered list, a life long medical record, continuity of care and managing a person rather than a single disease (all of which you are familiar with) but also reminding people that this is what they will lose if they do not support and invest in general practice.

People are listening to the real problems we face and now we need them to take action to help and support us.

This week has been interesting, with the latest publication from the Commonwealth Fund called Mirror, Mirror on the Wall,  2014 update, The Commonwealth Fund is  a USA based foundation that is well respected globally for its publications on comparisons of the performance of healthcare systems in different countries and most reports focus on 11 OECD  countries.

The report published this week declared the NHS as the best healthcare system in the world and the international panel reported the NHS was far superior to other countries who spend far more on health.

The report states “ the UK ranks first overall, scoring highest on quality, access and efficiency”. Not quite the message we receive via the daily media bashing!

The NHS also out-performs other countries, including France, Germany and Canada, in terms of managing patients with long-term conditions.

So well done you GPs and your practices, you see 90% of all patient contacts and we know the reason that the NHS generally provides high quality care, at less cost, with better outcomes than many OECD countries is because of the system of primary care that exists in the UK.  These are not my words but again have been stated repeatedly by the Commonwealth Fund.

The second issue that has got me thinking this week was the statement that the NHS has a £2bn funding gap.  Over the last few months we have been talking to anyone who would listen about the current trend towards out of hospital care.  

All agree that this is the only way that the NHS can survive. We have been making progress in terms of getting both commissioners and hospitals to understand that out of hospital care cannot be delivered unless additional resources are made available.

It is therefore interesting that hospitals are still looking to expand their workforce and Monitor, a body that oversees hospital trusts, are saying that cost pressures and additional work mean hospitals need more money.  Chris Ham from the Kings Fund is reported as saying that there is a real risk that some hospitals may “run out of money”!

Well, my reply is we need to introduce a system where general practice can also have the same status of cost pressures and a source of additional funding and it is time the Government woke up to the fact that general practice is severely challenged in terms of workload, recruitment and funding – some practices are already facing the reality of running out of money.

NHS England has also announced an additional £650m for the summer to help hospitals to reduce waits in A/E and waiting lists. Where is the matching sum to invest in the community?

My rant for the week is over – well, perhaps not, still some time for more.


1.    What is the LMC doing to help GPs?
2.    SMS messaging using NHSNet2. 
3.    Prescription direction
4.    Unplanned Admission guidance
5.    CQRS guides for 2014-15 enhanced services 
6.    Your GP Care – new resources
7.    New website and App for iPad and iPhones – why not an Android App?

8.    Building Resilience in Practice for GPs & PMs

1. What is the LMC doing to help GPs?

It is inevitable that when times are challenging people begin to ask what their representative body are doing to help and support them.

We do recognise how difficult it is at the present time.  

The three Medical Directors and myself have a variety of roles within our practices and so have first hand experience of these challenges and threats.

I am the Senior Partner in a large GMS Practice.

Gareth Bryant is the Managing Partner in a large PMS Practice.

Laura Edwards is a Salaried GP in a GMS Practice.

Sally Ross is the Senior Partner in a small GMS Practice.

Carole and Lisa are regularly attending Practice Manager Groups and are hearing first hand all the problems you are facing.

The LMC is focusing a great deal of effort on helping and supporting GPs, Practice Managers and Practices.  

Help and support is not enough, so we are also trying to raise the issues with other bodies and suggest potential solutions.

The recent survey the LMC undertook was really helpful is quantifying the issues and this allowed a wider debate on the challenges and opportunities.  

Many thanks to those who completed the surveys.  

Nearly 50% of GPs (1450) completed their survey and over 75% (372) of  Practice Managers completed their survey.

The recent press release can be found on the LMC website: 

The Press Releases associated with a motion proposed by Wiltshire LMC relating to getting more resource into general practice has resulted in significant coverage in newspaper both locally and nationally. I have also conducted a number of Radio and TV interview.

We have engaged with the following organisations in the last few weeks;

•    Clinical Senate
•    Health Education Wessex 
•    Wessex Area Team
•    BGSW Area Team
•    CCGs
•    GPC
•    NHS England
•    Wessex Deanery
•    Hospitals
•    Community Providers

Clinical Senate

At the last 2 meetings of the Senate, I have raised the issues of recruitment and retention of GPs and Practice Nurses as well as Practice Managers. The Senate has recently looked at issues such as vascular surgery configuration and the future of maternity and children’s services.

I have asked the Senate to consider the challenges faced by general practice and this has been supported by Simon Plint, the Postgraduate Dean.  I have been seeking the support of the CCGs and Area Team for this to be undertaken.

The Senate’s function is to advise NHS England and CCGs and a number of individuals from a variety of Commissioners and Providers are Board members.

Health Education Wessex (HEW)

HEW is part of Health Education England and has the responsibility for workforce planning and the delivery of education and training across all specialties. The Deanery was part of the SHA and is now part of HEW.

HEW has a Board made up of representatives of local providers including hospitals, community trusts and general practice.

At a recent development session I presented the current challenges that face general practice, suggesting that other providers should consider the consequences of what could happen to their organisations if general practice were not able to deliver the current service it does. 

As you are aware 340,000,000 consultations are undertaken in general practice every year.  That is equal to 1,000,000 consultations per day and accounts for 90% of all patient contacts. If general practice becomes less efficient and only sees 89% of these contacts the 1% fall equates to 10,000 additional appointments for hospitals each day, or a rise of about 10%.  That gets them thinking!

The LMC has been working with HEW to develop the training of undergraduate nurses and allied health care professionals, to ensure that a larger amount of time is spent in the community and general practice and to secure funding for the general practice placements.

Please see the attached letter.

Wessex Area Team

I meet regularly with the Managing Director, Medical Director and the Primary Care Directors to discuss the problems general practices faces and also potential solutions.

Recently at a meeting of the Area Team and all local CCGs I explored local challenges, solutions and the action that could be undertaken by commissioners to support and develop general practice and the wider services out of hospital.

BGSW Area Team

We have met with a number of individuals with particular focus on commissioning of primary care, PMS reviews and also the funding of GMS practices.

Clinical Commissioning Groups

The current issue that is topical is co-commissioning of primary care and the proposals to allow CCGs greater freedom to be involved in this area.  Please see my attached letter, which may be helpful in explaining the issues.

We meet all CCGs regularly and have broken down the results of our survey by individual CCGs. 

If the future is about general practice being delivered at scale, services wrapped around the patient, greater integration between health and social care, community services integrated with general practice and embedded in it, then all of this needs to be organised, co-ordinated and commissioned at CCG level.

We are working with the CCGs to help deliver this vision and get more resources for general practice.

The Government has committed £5 per patient or £250m to support the care of the patient over 75. This was part of the “Everybody Counts, Planning for patients document”which states that the CCGs are expected to invest this money to support practices in transforming the care of patients over 75 and avoiding unnecessary hospital admissions.  The document refers to practice plans and also giving practices a much greater say in the commissioning of community services and the development of integrated teams.

This is an item that we are discussing with each CCG as it is critical that this money is used wisely and truly supports GPs and practices to meet the needs of this ever expanding population.

The Better Care Fund (BCF) is about £2.3bn nationally, not new money but top sliced from health and social care to deliver more care out of hospital.  Social Care believe this will be an additional income stream with resources moving from health to social care, hospital stating they want their money back – so where does that leave us?  I personally believe these fund need to be invested to keep patient in the community and part of this resource needs to help practices or groups of practices to meet those needs.


General Practitioners Committee of the BMA

I am sure that you are aware of the launch of the recent campaign “Your GP Cares”. As a member of the GPC I have contributed to this but I am also pushing that greater pressure is applied nationally to find solutions to the problems we all face.

I have recently attended a national summit on the future of primary care – exploring the issues we all face and the potential solutions.  In a couple of weeks time we are hosting a regional meeting for the GPC so they can hear first hand of the situation we face in Wessex.



The LMC meets with most of the hospitals locally.  There has been a great deal of focus on what general practice can do to ease the pressure on hospital by reducing unnecessary referrals and avoidable hospital admissions.  

The focus needs to change to the hospitals giving greater focus on what they can do to support general practice in delivering out of hospital care.


Community Providers

The LMC believes it is essential to rebuild community teams that help and support GPs to provide care to their registered list.  We have had a decade of community nurses and their teams being pulled further and further away from practices.

The future of general practice will only be secured if there is greater support available to practices.  

Integrated care teams (ICTs) are discussed repeatedly – the LMC’s view remains that these will only deliver if they are embedded in general practice.

The LMC is discussing the future of community services with CCGs and community providers.

Public Health

We have recently met most Public Health leaders who now reside in the local authorities.  We are establishing good working relationship and trying to secure funding initially for sexual health services and also  NHS Health Checks.  

These relationships are important with the greater integration between health and social care.


As the elected body representing the population, ultimate responsibility for the provision of healthcare lies with the Government of the day.

The LMC has contacted all local MPs and raised the issues we face with them.  We are also aware that many GPs have written to their MP and some of these MPs have raised the issue with the Secretary of State.

The LMC will continue to do everything it can to help and support GPs and their practice. We will raise the issue at every opportunity and keep proposing solutions to the current problems.

I am going to the Houses of Parliament in a couple of weeks time specifically to put the case of general practice to the MP.

In addition, the LMC represents you at various premises meetings both with the Area Team and NHS Property Services where appropriate, Primary Care Commissioning Forums, local dispute resolution appeals panels, possible breach and performance panels, SBS re payment processes and also attend a number of other meetings where issues relating to primary care are important eg EPS2, the Hampshire Health Record and Summary Care Record, Healthwatch and last but not least, the Care Quality Commission! 

We are also looking at services that we believe you need but are not easily accessible and hence the development of greater provision of education and training for Practice Managers, Practice nurses and other Practice Staff provided by  Wessex LEAD  and delivered by Louise Greenwood. 

We also provide DBS checks (formerly known as CRB check).

If you think we could do more to support you and your practice please let us know.


2. SMS messaging using NHSNet

General Practice has been encouraged to improve communication with patients and to embrace modern technology.  

Many practices have taken advantage of the facilities to send SMS messages through NHSnet to send results or information to patients and also to confirm appointments and send reminders of forthcoming appointments.

You may also be aware you can send fax messages through NHSnet.

SMS messaging through NHSnet usage has ‘gone through the roof ‘and soaks up 1/3 of NHS Mail budget (£7mn of the £22mn budget). 

It has been announced that the NHS SMS/fax service will be closed down next April due to excess costs - the NHS pay 2p per message.

It would be unacceptable to offload these costs onto general practice and the GPC is lobbying for this cost to be met nationally.


3. Prescription direction

‘Prescription direction’ occurs where a patient is being directed by their GP practice to a certain pharmacy to have their prescription dispensed. Patients have a free choice between any community pharmacy and, in some cases, a GP dispensary. Actions by practices seeking to influence a patient’s choice of pharmacy can undermine relationships with patients, as well as damaging trust and cooperation between healthcare professionals. Financial arrangements between community pharmacies and GP practices should be transparent.

The British Medical Association, the Pharmaceutical Service Negotiating Committee and Pharmacy Voice agree that guidelines to ensure proper prescription practices should be followed. Providing advice that can be seen as prescription direction is against good practice. Whilst most of the following activities would be initiated by the practice, it is recognised that a pharmacy may often be involved. Pharmacy owners and pharmacists are also strongly advised not to request or become complicit in such activities.

The following list illustrates activities to avoid in order to maintain good practice:

•    Providing a practice endorsement for a pharmacy
•    Allowing a practice database to be used to facilitate the promotion of a pharmacy, or any other promotional activity
•    Suggesting that the practice/GP/member of staff would like a patient to use a particular pharmacy
•    Allowing a patient to believe that the level of care they receive from their medical practice could be influenced by their choice of pharmacy
•    Recommending that the patient collects a prescription from a certain pharmacy which is not the pharmacy that the patient had chosen
•    Manipulating the prescription management process in favour of a particular pharmacy, including, but not limited to, offering a pharmacy privileged access to prescriptions generated by the practice
•    Failing to be equitable when liaising with pharmacies, by offering differing levels of cooperation - such as for repeat prescriptions
•    Ignoring a patient’s freely stated choice of pharmacy
•    Misrepresenting a practice’s relationship with a pharmacy
•    Showing a lack of candour when providing information about dispensing and pharmacies (including, for example, making unsubstantiated or misleading claims about a particular pharmacy)
•    Failing to be transparent about a financial relationship between a practice and a pharmacy
•    Any other practice which is designed to unduly influence a patient’s choice of pharmacy

Where there is a financial link between a pharmacy and a medical practice, it is particularly important to ensure that appropriate procedures are in place to prevent prescription direction. A nominated partner and the superintendent pharmacist should oversee this, and ensure that everyone working in the pharmacy and medical practice is aware of their responsibilities.


4. Unplanned admissions enhanced service 

A “step by step” guide on the unplanned admissions enhanced service has now been added to the BMA website as web content as well as PDFs, to allow practices either to view the information electronically or to print it off to discuss it in practice meetings. 

The guidance is intended to minimise the administrative processes involved with the enhanced service, provide practical examples about how practices can meet the requirements and provide optional templates for practices to use to minimise bureaucracy for reporting purposes. 

When considering the workload associated with this enhanced service, practices should remember that they will no longer need to do the work involved in the QOF quality and productivity domain or remote monitoring and risk profiling DESs, as well as avoiding the bureaucracy involved in 238 clinical QOF points - all of which have been removed.  Much of the money involved has now been allocated to core GP funding, as part of the negotiated 2014/15 GP contract agreement.


5. CQRS guides for 2014-15 enhanced services 

The Calculating Quality Reporting Service (CQRS) has now been updated to support the following services (14/15) as of 4 June 2014: 

•  Rotavirus (Routine childhood vaccination) 
•  Learning disability health check scheme 
•  MMR aged 16 and over vaccination 
•  Meningitis C (freshers) vaccination 
•  Hepatitis B (newborn) vaccination 

This now allows practices to participate and provide achievement data for the services via the CQRS system. For the monthly programmes that began in April 2014 (MMR, Meningitis C and Hepatitis B), practices will need to enter the first three months of data into CQRS. These services will be manually entered on CQRS for the duration of the financial year. 

Guides on these enhanced services on CQRS can be found can be found online. For further information on CQRS, the service desk can be contacted via email:


6. Your GP Cares 

The “Your GP Cares” film is available to download from the BMA website. This link will take you to two boxes that require your name and email address.  Once completed you will be emailed a link which you can download from, removing the need for attachments that may be blocked by your local firewalls. 

Alternatively visit the “Your GP Cares” webpages and click on the link below the film for an audio-free version of the film to display on your surgery plasma screens. 

7. New website and App for iPad and iPhones – why not an Android App?

The LMC recently launch an App for the iPhone to improve access to information and services on the LMC website. This week we added an App for the iPad.  

In total over 250 people have downloaded the Apps in the last week.

According to the latest information I have iPads and iPhones account just over 60% of the market with Androids covering about 25%.  A number of you have contacted us and asked if we could provide an Android App as well.  We are working on this and hope to release it shortly.

To download the App go to the App store and search for Wessex LMCs or click here..


8. Building Resilience in Practice for GPs & PMs

Wessex LMCs are delighted to be working with John Perry, Lead for Healthcare Communication from the Faculty of Medicine, University of Southampton on a series of 4 half-day interactive workshops to enable further understanding of how the individual can cope with and build up their resistance to the ever increasing pressures in General Practice.
The delegates will need to commit to attending each of the 4 workshops, run over an 11 month period, and will be encouraged to work with one other delegate to support and encourage each other between sessions. In order for the delegates to get the most of out of the workshop series, a maximum of 10 delegates will be able to attend.
The course of workshops will run in Hook, Southampton, Blandford Forum and Devizes and the mornings are for PMs and the afternoons for GPs. More info is on our website:

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: co-commissioning.doc

Attached file: 140616-LMC-ltr-AJ-NW.doc

Attached file: letter-to-hospitals-June-2014-v2.doc

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Updated on 25 June 2014 2203 views